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 dollars 29 per death averted. The marginal cost-effectiveness of additional interventions was US dollars 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.