Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases

Nicholas G Reich; Justin Lessler; Jay K Varma; Neil M Vora

The framework presented is generally applicable, but given the lack of empirical cost information for the response to and monitoring of smallpox and MERS-CoV our analysis is strongly focused on Ebola. While we have used some of the best available data on large-scale active monitoring programs in our analyses, some potential costs and savings were not factored in to these calculations. The estimates available from DOHMH do not include the costs of cell phones given to monitored individuals, the staff time incurred by CDC and US Department of Homeland Security in screening travelers at airports, and the costs of evaluating individuals with symptoms that were not due to Ebola. More detailed cost data was not available from DOHMH, but such data could help to disentangle the fixed costs associated with running an active monitoring program from the cost per monitored individual. Additionally, we only presented gross cost estimates for the evaluation of a symptomatic individual under active monitoring from one NYC hospital, which was not representative of all hospitals in NYC. Finally, local considerations prompted DOHMH to opt for an active monitoring program involving humans to make and receive active monitoring reports from individuals. In contrast, other jurisdictions used digital systems to administer monitoring reports.(29) The merits of these different approaches deserve further investigation.