Appendix File

Additional results in tables.

Table A1 Time and costs expended by ambulance care services (N=25)

Professional / Unit costs / hour / No of hours / Base case costs/
service / Cost including overhead/service*
Coordination
medical manager / € 49 / 0-544 / 0-€26,656 / 0-€31,987
specialist nurse / € 42 / 0-306 / 0-€12,852 / 0-€15,422
Subtotal / €9,072-€26,656 / €10,886-€31,987
Meeting
medical manager / € 49 / 0-20 / 0-€980 / 0-€1,176
nurse / € 32 / 0-70 / 0-€2,240 / 0-€2,688
chauffeur / € 25 / 0-70 / 0-€1,750 / 0-€2,100
team manager / € 39 / 15-80 / €585-€3,120 / €702-€3,744
Subtotal / €3,030-€5,952 / €3,636-€7,142
Training
trainer / € 32 / 0-48 / 0-€1,536 / 0-€1,843
medical manager / € 49 / 0-3 / 0-€147 / 0-€176
specialist nurse / € 42 / 0-12 / 0-€504 / 0-€605
nurse / € 32 / 36-398 / €1152-€12,736 / €1,382-€15,283
chauffeur / € 25 / 36-398 / €900-€9,950 / €1,080-€11,940
team manager / € 39 / 12-181 / €468-€7,059 / €562-€8,472
Subtotal / €2988-€29,892 / €3,586-€35,870

*Wages are increased by 20% to account for overhead costs, depreciation, and housing costs

Training and instructing staff at ambulance services

Informing and instructing staff for EBV took mainly place during work meetings. Besides these meetings special training sessions, especially for donning and doffing were organized. From 4 ambulance care services we collected detailed information.

Table A2 Number of training sessions at ambulance services

Ambulance care services / No of ambulances / 100,000 inhabitants / No of inhabitants / No of meetings / No of persons / No of hours
1 / 3.4-4.1 / 484,986 / 4 / 17 / 3
2 / 4.1-4.8 / 531,591 / 12 / 4 / 2
3 / 3.4-4.1 / 774,476 / 1 / 220 (and 20) / 3 (8)
4 / 3.4-4.1 / 670,924 / 1 / 80 / 1

Source: AZN Nederland, names could not be disclosed

Table A3 Time and costs expended by peripheral hospitals (N=80)

Professional / Unit costs / No of hours / Base case cost / Costs including overhead*
Coordination
physician / € 81 / 0-139 / 0-€11,259 / 0-€16,213
infection prevention expert / € 37 / 173-519 / €6,401-€19,203 / €19,394-€27,652
manager / € 66 / 17-104 / €1,122-€6,864 / €1,616-€9,884
communication employee / € 28 / 0-139 / 0-€3,892 / 0-€5,604
Subtotal / €8,993-€35,476 / €12,950-€51,085
Meeting
physician / € 81 / 10-100 / €810-€8,100 / €1,166-€11,614
manager / € 66 / 10-50 / €660-€3,300 / €950-€4,752
communication employee / € 28 / 0-20 / 0-€560 / 0-€806
quality officer / € 42 / 0-10 / 0-€420 / 0-€605
Subtotal / €1,880-€11,960 / €2,707-€17,222
Protocol
physician / € 81 / 0-80 / 0-€6,480 / 0-€9,331
infection prevention expert / € 37 / 0-260 / 0-€9,620 / 0-€13,853
quality officer / € 42 / 0-40 / 0-€1,680 / 0-€2,419
Subtotal / €8,160-€17,735 / €11,750-€25,538
Training
physician / € 81 / 50-115 / €4,050-€9,315 / €5,832-€13,414
Nurse / € 32 / 60-265 / €1,920-€8,480 / €2,765-€12,211
physician assistant / € 33 / 83-185 / €2,739-€6,105 / €3,944-€8,791
quality officer / € 42 / 0-8 / 0-€336 / 0-€484
manager / € 66 / 23-55 / €1,518-€3,630 / €2,186-€5,227
other employee / € 30 / 0-10 / 0-€300 / 0-€432
Subtotal / €10,563-€29,930 / €15,211-€43,099

*Wages are increased by 44% to account for overhead costs, depreciation, and housing costs

Table A4 Time and costs expended by academic hospitals (N=8)

Professional / Unit
costs / No
of hours / Base case costs / Costs including overhead*
Coordination
physician / €79 / 500-624 / €39,500-€49,296 / €56,880-€70,986
infection prevention expert / €37 / 779 / €28,823 / €41,505
assistant infection prevention specialist / €28 / 0-779 / 0-€21,812 / 0-€31,409
manager / €66 / 0-500 / 0-€33,000 / 0-€47,520
head of group / €66 / 0-500 / 0-€33,000 / 0-€47,520
policy maker / €42 / 0-779 / 0-€32,718 / 0-€47,114
Subtotal / €68,323-€176,837 / €98,385-€254,645
Meeting
physician / €79 / 20-958 / €1,580-€75,682 / €2,275-€108,982
manager / €66 / 0-400 / 0-€26,400 / 0-€38,016
other employee / €30 / 0-400 / 0-€12,000 / 0-€17,280
representative board / €82 / 0-20 / 0-€1,640 / 0-€2,362
Subtotal / €3,220-€138,910 / €4,637-€200,030
Protocol
physician / €79 / 20-40 / €1,580-€3,160 / €2,275-€4,550
manager / €66 / 0-30 / 0-€1,980 / 0-€2,851
Nurse / €32 / 0-60 / 0-€1,920 / 0-€2,765
other employee / €30 / 10-300 / €300-€9,000 / €432-€12,960
policy maker / €42 / 0-20 / 0-€840 / 0-€1,210
Subtotal / €1,880-€15,270 / €2,707-€21,989
Training
physician / €79 / 109-486 / €8,611-€38,394 / €12,400-€55,287
Nurse / €32 / 191-1000 / €6,112-32,000 / €8,801-€46,080
physician assistant / €33 / 183-380 / €6,039-€12,540 / €8,696-€18,058
communication employee / €28 / 6-120 / €168-€3,360 / €242-€4,838
other employee / €30 / 20-240 / €600-€7,200 / €864-€10,368
manager / €66 / 20-120 / €1,320-€7,920 / €1,901-€11,405
security personnel / €28 / 0-100 / 0-€2,800 / 0-€4,032
Subtotal / €23,828-€75,024 / €34,312-€108,035

*Wages are increased by 44% to account for overhead costs, depreciation, and housing costs

Training and instructing staff at hospitals

In several ways personnel was trained and instructed for EBV, for example during EBV information meetings organized for a large group of personnel or on a small scale with a few persons during work time.

Table A5 Number of employees trained for Ebola in hospitals

Type of hospital / No of beds / No of hospital admissions / No persons participating in large training (4-8 hours) / No of persons involved in general instructions (1-2 hours) / No of persons instructed for donning and doffing (0.5-1 hour)
Academic / 1320 / 41773 / 46 / 200 / 420
Academic / 953 / 31137 / 300 / - / 624
Academic / 882 / 23033 / 125 / - / 840
Academic / 733 / 27058 / 18 / 100 / 150
Academic / 1042 / 34902 / 30 / 150 / 279
Peripheral / 818 / 37702 / 7 / 36 / 150
Peripheral / 809 / 34144 / - / 50 / 280
Peripheral / 1116 / 44698 / 50 / - / 600

Source for no of beds and hospital admissions: academic hospitals: Rathenau Instituut, De Nederlandse universitaire

ziekenhuizen, feiten en cijfers, 2014. No of beds and hospital admissions for the peripheral hospitals were retrieved

from facts and figures from individual hospital websites (names could not be disclosed).

Table A6 Estimated costs of the admitted EVD patienta

Cost category / Costs / hour or unit costs (€) / No of employees / No of hours / Patient days / Total
(€)
Transportation ambulance / 5,278
Intake
nurses / 32 / 4 / 8 / 1 / 1,024
infectious diseases specialist / 113 / 1 / 8 / 1 / 904
guard / 28 / 1 / 24 / 1 / 672
Daily meeting
manager / 66 / 2 / 1 / 14 / 1,848
nurses / 32 / 3 / 1 / 14 / 1,344
communication employee / 42 / 1 / 1 / 14 / 588
infectious diseases specialist / 113 / 1 / 1 / 14 / 1,582
other physicians / 113 / 2 / 1 / 14 / 3,164
Admission
infectious diseases specialist / 113 / 1 / 4 / 14 / 6,328
medical microbiologist / 113 / 1 / 1 / 14 / 1,582
nurses / 32 / 9 / 8 / 14 / 32,256
manager / 66 / 1 / 4 / 14 / 3,696
communication employee / 42 / 1 / 1 / 14 / 588
guard / 28 / 3 / 8 / 14 / 9,408
admission costs per day / 1313 / 14 / 18,382
closure 3 other isolation units / 1313 / 14 / 55,146
closure isolation unit for another 14 days / 1313 / 14 / 18,382
Diagnostics:
I-STAT portable clinical analyzer / 2,000 / 2,000
PCR: 2*121,50 / 729
transportation costs to Bernard Nocht Institut 2*1200 / 2,400
other diagnostics at Erasmus Virology laboratory 7*500 / 3,500
Cleaning costs / 35,000
Costs PPE / 50 / 25 / 14 / 17,500
Labour time MHS
nurses / 33 / 55 / 1,815
physicians / 49 / 165 / 8,085
policymaker / 42 / 40 / 1,680
communication employee / 36 / 16 / 576
manager / 49 / 4 / 196
vice-director / 63 / 4 / 252
director / 76 / 4 / 304
Total / 236,209

a Based on information and resource use from interviews.

PPE=personal protective equipment

Table A7 Costs expended by virological laboratory (N=1)

Professional / Costs / hour (€) / Mean no hours
(range) / Mean total costs
base case
* €1000 (range) / Mean total costs including overheadb
* €1000 (range)
medical staff / 79 / 2100
(1900-2300) / 165.9
(150.1-181.7 / 238.9
(216.1-261.7)
medical microbiological analyst / 30 / 1550
(1440-1700) / 46.5
(42.0-51.0) / 67.0
(60.5-73.4)
Subtotal / 212.4
(192.1-232.7) / 305.9
(276.6-335.1)
Diagnosticsa / No / Costs (€) / Total (€)
PCR Ebola / 42 / 122 / 5,103
PCR Lassa / 23 / 122 / 2,795
PCR Marburg / 22 / 122 / 2,673
Malaria quick test / 7 / 30 / 210
PCR Malaria / 3 / 122 / 365
PCR Crimean Congo / 18 / 122 / 2,187
If IgG Ebola / 1 / 32 / 32
PCR Leptospirosis / 14 / 122 / 1,701
clinical chemical tests / 14 / 500 / 7,000
transportation to Germany c / 11 / 1,200 / 13,200
Subtotal / 35,265
Total base case / 247,665
(227,365-267,965)
Total including overhead costs / 341,121
(311,889-370,353)
a In addition, costs for diagnostics for the EVD patient (€6629, table 3) were performed at the virological laboratory.
b Wages are increased by 44% to account for overhead costs, depreciation, and housing costs
c For confirmation of diagnosis at Bernard Nocht Institut.

Table A8 Time and costs expended by public health institutes

Professionals / Mean no of hours
(range) / Costs per hour (€)
(base case) / Base case
mean total costs (€)
(range) / Costs per hour (€) incl. overhead costs / Mean total costs (€) incl. overhead
(range)
MHSs (N=25)
public health nurse / 201
(102-484) / 33 / 6,599
(3,351-15,903) / 68 / 13,697
(6,956-€ 33,009)
communication employee / 76
(6-294) / 36 / 2,738
(217-10,614) / 84 / 6,370
(504-€ 24,696)
policy maker / 268
(0-1504) / 42 / 11,317
(0-63,474) / 92 / 24,761
(0-138,869)
public health physician / 506
(288-484) / 49 / 24,751
(14,079-23,660) / 104 / 52,406
(29,808-50,094)
manager / 80
(6-220) / 49 / 3,886
(293-10,754) / 104 / 8,228
(621-22,770)
Total / 1131
(402-2986) / 49,292
(17,940-124,404) / 105,461
(37,889-269-438)
All MHSs / 1,232,290
(448,496-3,110,102) / 2,636,533
(947,235-6,735,953)
RIVM (N=1)
assistants / 145 / 22 / 3190 / 76 / 11,020
policy makersa, epidemiologists / 912 / 31 / 28,272 / 88 / 80,256
policy makersb, / 1770 / 42 / 74,340 / 104 / 184,080
managers, medical doctors / 1558 / 56 / 87,248 / 124 / 193,192
Subtotal / 4385 / 193,050 / 468,548
Costs for materials / 37,867 / 37,867
Total / 230,959 / 506,415

a junior, b senior

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