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Cost Analysis of 3 Concurrent Public Health Response Events

Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County

McCullough, J. Mac PhD, MPH; Fowle, Nicole LPN; Sylvester, Tammy MSN, RN; Kretschmer, Melissa MA; Ayala, Aurimar MPH; Popescu, Saskia MPH, MA, CIC; Weiss, Jolie PhD; England, Bob MD, MPH

Journal of Public Health Management and Practice: July/August 2019 - Volume 25 - Issue 4 - p 357–365
doi: 10.1097/PHH.0000000000000818
Research Reports: Research Full Report

Objective: To generate estimates of the direct costs of mounting simultaneous emergency preparedness and response activities to respond to 3 major public health events.

Design: A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs.

Setting: Maricopa County Department of Public Health (MCDPH) in Arizona. The nation's third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa's more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015.

Participants: Time data were sought from all MCDPH staff who participated in activities related to any of the 3 relevant responses. In addition, time data were sought from partners at the state health department and a community hospital involved in response activities. Time estimates were received from 128 individuals (response rate 88%).

Main Outcome Measure: Time and cost to MCDPH for each response and overall.

Results: Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224 484 (>5800 hours). The majority was for personnel ($203 743) and the costliest response was measles ($122 626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period.

Conclusions: Funding for public health departments remains limited, yet public health responses can be cost- and time-intensive. To effectively plan for future public health responses, it may be necessary to share experiences and financial lessons learned from similar public health responses. External partnerships represent a key contribution for responses such as those examined. It can be expensive for local public health departments to mount effective responses, especially when multiple responses occur simultaneously.

Department of Public Health, Maricopa County, Phoenix, Arizona (Drs McCullough and England, and Mss Fowle, Sylvester, Kretschmer, and Ayala); School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona (Dr McCullough); Phoenix Children's Hospital, Phoenix, Arizona (Ms Popescu); and Arizona Department of Health Services, Phoenix, Arizona (Dr Weiss).

Correspondence: J. Mac McCullough, PhD, MPH, School for the Science of Health Care Delivery, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004 (

The authors gratefully acknowledge the valuable contributions of all individuals who contributed to these 3 public health responses. In particular, the authors acknowledge individuals in the MCDPH Office of Epidemiology, MCDPH Office of Preparedness and Response, MCDPH Office of Community Wellness and Health Promotion, Arizona Department of Health Services Office of Infectious Disease Services, the Phoenix Children's Hospital, the University of Arizona SAFER students and faculty, and individuals who contributed to these responses while serving as CDC EIS and PHAP positions. The authors especially acknowledge Dr Rebecca Sunenshine for her invaluable contributions to these public health responses and to the preparation of this article.

The conclusions, findings, and opinions in this article do not necessarily reflect the official position of the agencies named previously or the US Department of Health and Human Services, the Public Health Service.

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.