Indirect costs associated with deaths from the Ebola virus disease in West Africa.
BACKGROUND
By 28 June 2015, there were a total of 11,234 deaths from the Ebola virus disease (EVD) in five West African countries (Guinea, Liberia, Mali, Nigeria and Sierra Leone). The objective of this study was to estimate the future productivity losses associated with EVD deaths in these West African countries, in order to encourage increased investments in national health systems.


METHODS
A cost-of-illness method was employed to calculate future non-health (NH) gross domestic product (GDP) (NHGDP) losses associated with EVD deaths. The future non-health GDP loss (NHGDPLoss) was discounted at 3 %. Separate analyses were done for three different age groups (< =14 years, 15-44 years and = >45 years) for the five countries (Guinea, Liberia, Mali, Nigeria, and Sierra Leone) affected by EVD. We also conducted a one-way sensitivity analysis at 5 and 10 % discount rates to gauge their impacts on expected NHGDPLoss.


RESULTS
The discounted value of future NHGDPLoss due to the 11,234 deaths associated with EVD was estimated to be Int$ (international dollars) 155,663,244. About 27.86 % of the loss would be borne by Guinea, 34.84 % by Liberia, 0.10 % by Mali, 0.24 % by Nigeria and 36.96 % by Sierra Leone. About 27.27 % of the loss is attributed to those aged under 14 years, 66.27 % to those aged 15-44 years and 6.46 % to those aged over 45 years. The average NHGDPLoss per EVD death was estimated to be Int$ 17,473 for Guinea, Int$ 11,283 for Liberia, Int$ 25,126 for Mali, Int$ 47,364 for Nigeria and Int$ 14,633 for Sierra Leone.


CONCLUSIONS
In spite of alluded limitations, the estimates of human and economic losses reported in this paper, in addition to those projected by the World Bank, show that EVD imposes a significant economic burden on the affected West African countries. That heavy burden, coupled with human rights and global security concerns, underscores the urgent need for increased domestic and external investments to enable Guinea, Liberia and Sierra Leone (and other vulnerable African countries) to develop resilient health systems, including core capacities to detect, assess, notify, verify and report events, and to respond to public health risks and emergencies.
Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo. kirigiaj@who.int.
Joses Muthuri
JM
Kirigia
Department of Economics, University of Zambia, Lusaka, Zambia. fmasiye@yahoo.com.
Felix
F
Masiye
The KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. dkirigia@kemri-wellcome.org.
Doris Gatwiri
DG
Kirigia
School of Public Health, University of Ghana, Accra, Ghana. akweongo@gmail.com.
Patricia
P
Akweongo
D000293:Adolescent; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D000368:Aged; D002648:Child; D003365:Costs and Cost Analysis; D003643:Death; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D055815:Young Adult