Multisectoral cost analysis of a human and livestock anthrax outbreak in Songwe Region, Tanzania (December 2018-January 2019), using a novel Outbreak Costing Tool

Abstract

Objectives: We applied a novel Outbreak Costing Tool (OCT), developed by the US Centers for Disease Control and Prevention (CDC), to estimate the costs of investigating and responding to an anthrax outbreak in Tanzania. We also evaluated the OCT's overall utility in its application to a multisectoral outbreak response.

Methods: We collected data on direct costs associated with a human and animal anthrax outbreak in Songwe Region (December 2018 to January 2019) using structured questionnaires from key-informants. We performed a cost analysis by entering direct costs data into the OCT, grouped into seven cost categories: labor, office, travel and transport, communication, laboratory support, medical countermeasures, and consultancies.

Results: The total cost for investigating and responding to this outbreak was estimated at 102,232 United States dollars (USD), with travel and transport identified as the highest cost category (62,536 USD) and communication and consultancies as the lowest, with no expenditure, for the combined human and animal health sectors.

Conclusions: Multisectoral investigation and response may become complex due to coordination challenges, thus allowing escalation of public health impacts. A standardized framework for collecting and analysing cost data is vital to understanding the nature of outbreaks, in anticipatory planning, in outbreak investigation and in reducing time to intervention. Pre-emptive use of the OCT will also reduce overall and specific (response period) intervention costs for the disease. Additional aggregation of the costs by government ministries, departments and tiers will improve the use of the tool to enhance sectoral budget planning for disease outbreaks in a multisectoral response.

Keywords: Anthrax; Cost analysis; Infectious disease outbreak; One Health; Outbreak Costing Tool; Tanzania.

Fig. 1

Timeline of the number of reported suspected human anthrax cases (n = 81) during the outbreak period in Songwe Region, Tanzania, from December 2018 to January 2019.

Fig. 2

Age range (years) and sex distribution for reported suspected human anthrax cases (n = 79 with data available) during the outbreak period in Songwe Region, Tanzania, from December 2018 to January 2019.

Fig. 3

Total cost per individual cost category in United States dollars (USD) for an anthrax outbreak in Songwe Region, Tanzania, from December 2018 to January 2019. Note: The equivalent cost categories of total expenditure in Tanzanian shillings (TSH) are as follows: Labor; 34,384,666 TSH (14,957 USD), Office; 2,860,000 TSH (1244 USD), Travel and Transport; 143,760,000 TSH (62,536 USD), Communication; 0 TSH (0 USD), Laboratory Support; 19,112,000 TSH (8314 USD), Medical Countermeasures; 18,900,000 TSH (8222 USD), and Consultancies; 0 TSH (0 USD).

Fig. 4

Total individual category costs in United States dollars (USD) across three defined outbreak investigation and response periods for an anthrax outbreak in Songwe Region, Tanzania, from December 2018 to January 2019. Note: The equivalent cost categories of total expenditure in Tanzanian shillings (TSH) for the Initial Response Period are as follows: Labor; 13,531,242 TSH (5886 USD), Office; 1,144,000 TSH (498 USD), Travel and Transport; 3,285,000 TSH (1429 USD), Laboratory Support; 9,143,500 TSH (3977 USD), Medical Countermeasures; 0 TSH (0 USD). For the Outbreak Response Period: Labor; 15,203,246 TSH (6613 USD), Office; 572,000 TSH (249 USD), Travel and Transport; 113,940,000 TSH (49,564 USD), Laboratory Support; 9,968,500 TSH (4336 USD), and Medical Countermeasures; 34,900,000 TSH (15,182 USD). For the Follow up and Reporting Period: Labor; 5,650,177 TSH (2458 USD), Office; 1,144,000 TSH (498 USD), Travel and Transport; 26,535,000 TSH (11,523 USD), Laboratory Support; 0 TSH (0 USD), and Medical Countermeasures; 0 TSH (0 USD). The cost categories: communication and consultancies, are not shown as there was no associated expenditure.

Fig. 5

Percentage labor and non-labor costs across three defined outbreak investigation and response periods for an anthrax outbreak in Songwe Region, Tanzania, from December 2018 to January 2019. Note: Non-labor category grouping includes the cost categories: office supplies and equipment, travel and transport, laboratory support and medical countermeasures. The cost categories: communication and consultancies, are not shown as there was no associated expenditure.