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Cost Comparison Between 2 Responses to Hepatitis A Virus Incidents in Restaurant Food Handlers—New York City, 2015 and 2017

Baum, Sarah E. BA; Reddy, Vasudha MPH; Vora, Neil M. MD; Balter, Sharon MD, MFA; Daskalakis, Demetre MD, MPH; Barbot, Oxiris MD; Misener, Mark MD, MPH; Rakeman, Jennifer PhD; Rojas, John MPA; Starr, David MIA; Waechter, HaeNa MPH; Zucker, Jane MD, MSc; Lee, David MBA, MPH

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000895
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Context: While the New York City Department of Health and Mental Hygiene (DOHMH) can use agency-wide emergency activation to respond to a hepatitis A virus–infected food handler, there is a need to identify alternative responses that conserve scarce resources.

Objective: To compare the costs incurred by DOHMH of responding to a hepatitis A case in restaurant food handlers using an agency-wide emergency activation (2015) versus the cost of collaborating with a private network of urgent care clinics (2017).

Design: We partially evaluate the costs incurred by DOHMH of responding to a hepatitis A case in a restaurant food handler using agency-wide emergency activation (2015) with the cost of collaborating with a private network of urgent care clinics (2017) estimated for a scenario in which DOHMH incurred the retail cost of services rendered.

Results: Costs incurred by DOHMH for emergency activation were $65 831 ($238 per restaurant employee evaluated) of which DOHMH personnel services accounted for 85% ($55 854). Costs of collaboration would have totaled $50 914 ($253 per restaurant employee evaluated) of which personnel services accounted for 6% ($3146).

Conclusions: Accounting for incident size, collaborating with the clinic network was more expensive than agency-wide emergency activation, though required fewer DOHMH personnel services.

Division of Disease Control (Mss Baum, Reddy, and Waechter, Drs Vora, Daskalakis, Rakeman, and Zucker, and Messrs Rojas and Lee), Office of First Deputy Commissioner (Dr Barbot), and Office of Emergency Preparedness and Response (Dr Misener and Mr Starr), Department of Health and Mental Hygiene, Long Island City, New York; Career Epidemiology Field Officer Program (Dr Vora) and Immunization Services Division (Dr Zucker), Centers for Disease Control and Prevention, Atlanta, Georgia; and Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California (Dr Balter).

Correspondence: David Lee, MBA, MPH, Division of Disease Control, New York City Department of Health and Mental Hygiene, 42-09 28th St, Long Island City, NY 11101 (dlee8@health.nyc.gov).

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the New York City Department of Health and Mental Hygiene.

The authors declare no conflicts of interest.

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