RIH infectious disease control researchers estimate $360-million national cost for Ebola preparedness

March 16, 2017

A Rhode Island Hospital study put a conservative $360-million price tag on U.S. hospitals’ response to Ebola crisis in 2014  and recommends improvements to future public health preparedness practices related to efficient and appropriate allocation of resources.

The study, published earlier this week in the journal Infection Control and Hospital Epidemiology, was authored by Rhode Island Hospital’s Michael A. Smit, M.D., M.S.P.H., pediatric infectious diseases specialist and associate medical director of the Rhode Island Hospital Department of Epidemiology & Infection Control, and Leonard A. Mermel, D.O., Sc.M., adult infectious diseases specialist and medical director of the Rhode Island Hospital Department of Epidemiology & Infection Control, who collaborated with colleagues from The Joint Commission, University of Maryland Medical Center and Johns Hopkins Hospital on the study, “Ebola Preparedness Resources for Acute-Care Hospitals in the United States: A Cross-Sectional Study of Costs, Benefits, and Challenges.”

“With the massive effort across the country to ensure we were prepared for this often-deadly viral disease, there were wide variations in needs and approach, and it was our hope to learn more about potential efficiencies for future public health emergencies of this scope,” said Smit.

The researchers set out to put a price on the supplies and staff overtime required for hospitals to prepare for the 2014 West African outbreak of the Ebola viral disease that threatened to become a global health crisis. In addition to costs, the survey instrument captured challenges, benefits and perceived value of preparedness efforts. Responses were collected from more than 200 hospitals in 45 states and the District of Columbia, then classified by size, type, region, location and teaching affiliation.

Significant findings include:

  • Overall cost for acute care hospitals in the U.S. to prepare for possible Ebola viral disease cases was estimated to be $361,108,968. 
  • The average amount spent by hospitals on combined supply and overtime labor costs was $80,461. 
  • The range of total supply and staff costs was from a low of $1,457 to a high of $760,367. Adjusted for bed count, those costs were between $159 and $250,000 per 100 beds.
  • Overtime cost in smaller hospitals was more than three times greater than larger hospitals.
  • The leading challenge was difficulty obtaining supplies from vendors due to shortages.
  • The greatest benefit cited was improved knowledge about personal protective equipment.  

“Comparing costs, challenges and benefits, the majority of hospitals also provided positive assessments of the overall value of preparing for potential Ebola cases,” said Barbara I. Braun Ph.D., study co-investigator with The Joint Commission team.

Smit and Mermel agree that this may be a conservative snapshot of expenditures, given how much of the staff time, equipment and supplies may have been absorbed into general operations without a thorough accounting attributed to Ebola preparation. But the lessons, they say, are notable.

“We hope that this work will assist us in future planning efforts,” said Dr. Mermel. “The financial impact of Ebola virus disease preparedness activities was substantial. The evidence makes a strong case that future emerging infectious disease identification, triage, and management should be conducted at the regional and national levels to facilitate efficient and appropriate allocation of resources in acute care facilities.”

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Christina Spaight O'Reilly

Rhode Island Hospital