Strengthening health services to control epidemics: empirical evidence from Guinea on its cost-effectiveness

OBJECTIVE To assess the cost-effectiveness of control measures implemented against epidemics in Guinea, West Africa. METHODS We collected all routine data available on incidence, mortality, control measures implemented and their cost during epidemics of cholera, measles and meningococcal meningitis in 1993-95. Then we estimated for one prefecture the effectiveness and cost-effectiveness of epidemic control measures for three scenarios: (i) 'natural' situation, (ii) 'routine' health services and (iii) 'intervention'. Where uncertainty was considerable, we used sensitivity analysis and estimated ranges. FINDINGS Routine health services reduced potential deaths by 51% (67%, 37% and 60% for cholera, measles and meningitis, respectively), and additional interventions further decreased potential deaths by 28% (28%, 27% and 30% for cholera, measles and meningitis, respectively). The marginal cost-effectiveness of epidemic control measures in routine health services was US$29 per death averted. The marginal cost-effectiveness of additional interventions was US$93 per death averted. CONCLUSION Even with the data weaknesses that characterize situations of epidemics it is possible to show that strengthening health services to control epidemics as was performed in Guinea was highly cost-effective. Moreover, sensitivity analysis over a range of assumptions confirms that (i) well-functioning health services averted the major part of avoidable deaths, (ii) combining existing health services with additional interventions minimizes the health impact of epidemics and (iii) case management should be a cornerstone of control of epidemics of cholera, measles and meningococcal meningitis.