title: Evaluation of economic costs of a measles outbreak and outbreak response activities in Keffa Zone, Ethiopia.
abstract: OBJECTIVE
  To estimate the economic impact of a measles outbreak and response activities that occurred in Keffa Zone, Ethiopia with 5257 reported cases during October 1, 2011-April 8, 2012, using the health sector and household perspectives.
  
  
  METHODS
  We collected cost input data through interviews and record reviews with government and partner agency staff and through a survey of 100 measles cases-patients and their caretakers. We used cost input data to estimate the financial and opportunity costs of the following outbreak and response activities: investigation, treatment, case management, active surveillance, immunization campaigns, and immunization system strengthening.
  
  
  RESULTS
  The economic cost of the outbreak and response was 758,869 United States dollars (US$), including the opportunity cost of US$327,545 (US$62.31/case) and financial cost of US$431,324 (US$82.05/case). Health sector costs, including the immunization campaign (US$72.29/case), accounted for 80% of the economic cost. Household economic cost was US$29.18/case, equal to 6% of the household median annual income. 92% of financial costs were covered by partner agencies.
  
  
  CONCLUSIONS
  The economic cost of the measles outbreak was substantial when compared to household income and health sector expenditures. Improvement in two-dose measles vaccination coverage above 95% would both reduce measles incidence and save considerable outbreak-associated costs to both the health sector and households.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA. Electronic address: awallace@cdc.gov.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Wallace
authors.affiliation: Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Republic of Congo.
authors.forename: Balcha G
authors.initials: BG
authors.lastname: Masresha
authors.affiliation: Immunization and Vaccines Development Programme, World Health Organization, Addis Ababa, Ethiopia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Grant
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Goodson
authors.affiliation: General Policy, Planning and Finance Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Hailye
authors.initials: H
authors.lastname: Birhane
authors.affiliation: Immunization and Vaccines Development Programme, World Health Organization, Addis Ababa, Ethiopia.
authors.forename: Meseret
authors.initials: M
authors.lastname: Abraham
authors.affiliation: General Policy, Planning and Finance Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Tewodros B
authors.initials: TB
authors.lastname: Endailalu
authors.affiliation: Operations Research Directorate, Regional Ministry of Health, Southern Nations, Nationalities and Peoples' Region, Awasa, Ethiopia.
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Letamo
authors.affiliation: Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Republic of Congo.
authors.forename: Amos
authors.initials: A
authors.lastname: Petu
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods*; D004196:Disease Outbreaks; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008457:Measles / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Economic; Measles; Outbreak