SYSTEMATIC SYNTHESIS OF DIRECT EBOLA OUTBREAK RESPONSE COSTS FOR COST-EFFECTIVENESS MODELLING
Author(s)
Abigail Hunter, BSc1, Katharina Hauck, PhD2, Gemma Nedjati-Gilani, PhD2, Janetta Skarp, PhD2, Carl Pearson, PhD3;
1King's College London, London, United Kingdom, 2Imperial College London, London, United Kingdom, 3University of North Carolina at Chapel Hill, North Carolina, NC, USA
1King's College London, London, United Kingdom, 2Imperial College London, London, United Kingdom, 3University of North Carolina at Chapel Hill, North Carolina, NC, USA
OBJECTIVES: To collate and synthesise existing evidence on the direct costs of Ebola Virus Disease (EVD) outbreak response in Central and West Africa, identify gaps limiting robust cost-effective analysis, and construct a structured cost database for integration into a dynamic transmission model evaluating vaccination and response strategies.
METHODS: A systematic review was conducted following PRISMA guidelines across PubMed, EMBASE, and Scopus (1990-present). Grey literature, operational reports, and expenditure records were identified through targeted searches and reference mining. All eligible cost data were extracted into a standardised REDCap instrument capturing cost component, unit bases, activity data, and perspectives relevant to national systems and multilateral responders. Costs were inflated and converted to 2024 USD. Each cost item was classified as fixed, fixed-variable, or variable according to its scaling with outbreak size or geographic spread. Items were assessed for relevance, methodological quality, and suitability for attachment to model outputs to enable cost-effectiveness analyses.
RESULTS: From 3,997 screened records, 15 peer- reviewed studies and 27 additional data sources were included. Across sources, 269 cost items were identified, but only 27 (10%) were sufficiently disaggregated and compatible with epidemiological model requirements. Available evidence was concentrated in the 2014-2016 West Africa and 2018-2020 DRC outbreaks. Major cost drivers included personnel and travel, Ebola Treatment Centre construction and operations, infection prevention and control, surveillance, and safe and dignified burials. Despite comprehensive extraction, the systematic review informed only a minority of model cost inputs; around 80% of required costing relied on expert review due to gaps in unit costs, activity data, and operational reporting.
CONCLUSIONS: Current evidence on EVD outbreak response costs is highly fragmented and insufficient to support fully empirical cost-effectiveness modelling. Strengthening routine cost capture, standardising reporting standards, and improving access to expenditure data from implementing agencies are critical to enable robust economic evaluation of outbreak response and vaccination strategies.
METHODS: A systematic review was conducted following PRISMA guidelines across PubMed, EMBASE, and Scopus (1990-present). Grey literature, operational reports, and expenditure records were identified through targeted searches and reference mining. All eligible cost data were extracted into a standardised REDCap instrument capturing cost component, unit bases, activity data, and perspectives relevant to national systems and multilateral responders. Costs were inflated and converted to 2024 USD. Each cost item was classified as fixed, fixed-variable, or variable according to its scaling with outbreak size or geographic spread. Items were assessed for relevance, methodological quality, and suitability for attachment to model outputs to enable cost-effectiveness analyses.
RESULTS: From 3,997 screened records, 15 peer- reviewed studies and 27 additional data sources were included. Across sources, 269 cost items were identified, but only 27 (10%) were sufficiently disaggregated and compatible with epidemiological model requirements. Available evidence was concentrated in the 2014-2016 West Africa and 2018-2020 DRC outbreaks. Major cost drivers included personnel and travel, Ebola Treatment Centre construction and operations, infection prevention and control, surveillance, and safe and dignified burials. Despite comprehensive extraction, the systematic review informed only a minority of model cost inputs; around 80% of required costing relied on expert review due to gaps in unit costs, activity data, and operational reporting.
CONCLUSIONS: Current evidence on EVD outbreak response costs is highly fragmented and insufficient to support fully empirical cost-effectiveness modelling. Strengthening routine cost capture, standardising reporting standards, and improving access to expenditure data from implementing agencies are critical to enable robust economic evaluation of outbreak response and vaccination strategies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE230
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Infectious Disease (non-vaccine)