Disease — Measles Expensive

Measles are really expensive

Much virtual ink has been spilled in the past several weeks about what an awful disease measles can be, about the impact of irresponsible doctors’ advice, and about the ramifications of not vaccinating on those unable to be vaccinated.

But only a handful of folks have talked about costs. Measles is expensive. Really expensive. And even if you live in a highly vaccinated area with no outbreaks, a measles case in your state – that’s a third of the U.S. right now – still means health department tax dollars diverted from other programs to deal with a disease that was eliminated from the U.S. in 2000.

“These outbreaks have economic costs. They are disruptive,” said Gregory Poland, head of the Mayo Clinic's Vaccine Research Group. “The smaller ones have cost a couple hundred dollars in public resources, and one cost nearly a million dollars. It’s on the lesser side – health is more important – but it consumes public health resources that could be applied to the other pressing problems we face.”

In 2011, the cost of 107 cases spread across 16 outbreaks cost local and state health departments an estimated $2.7 million to $5.3 million. Because measles is so contagious, infecting 90 percent of susceptible individuals and remaining airborne up to two hours after an infectious person has left the area, the number of contacts a single case can generate grows exponentially once an outbreak begins. The cases in 2011 involved contacting somewhere between 8,900 and 17,450 individuals, which required 42,000 to 83,000 personnel hours.

The outbreak tied to Disneyland is responsible for approximately 85% of the cases to date. Photo from the CDC.

The outbreak tied to Disneyland is responsible for approximately 85% of the cases to date. Photo from the CDC.

During another outbreak in 2008, during which an intentionally unvaccinated 7-year-old boy returned from Switzerland with the virus, San Diego grappled with 11 additional cases, costing taxpayers $10,376 per case. That outbreak involved more than 800 exposed individuals, including 48 children too young to be vaccinated who had to be quarantined at a family cost of $775 per child.

Among the ten measles cases in Illinois, eight are infants too young to be vaccinated, which means it’s highly likely that other infants in those classrooms were exposed and may need to be quarantined for up to three weeks. If so, the costs will very likely be higher than they were in 2008.

Then there are the family costs of an actual measles case, which lasts about seven to ten days, though those costs are a bit harder to measure, according to health economist Adam Powell, president of Payer+Provider Syndicate Healthcare Consulting.

“While this cost can be absorbed by many employees through the use of sick days, employees with lower incomes are the least likely to have sick leave,” Powell said. “The Economic Policy Institute reported that the median wage for people without sick days is $10 per hour. Assuming the person works five days a week, missing a week of work would cause a loss of $400. If the absence extended to eight days of work and two days of weekend as a result of a ten day illness, the loss would be $640.”

But that figure only accounts for an estimate of lost wages, not the any additional costs such as hospitalization. “After factoring in the cost of medical care, expenses could be even higher,” Powell said.

Contrast those numbers with the cost of the MMR (measles-mumps-rubella) vaccine, which prevents the measles in 95 percent of those who get one dose and 99 percent of those who get both doses. A provider under a CDC contract, such as those using the Vaccines for Children program, pays $19.91* for a single pediatric dose of MMR (or $37.04* for an adult dose), and the private sector price is $59.91*.

Even those costs are not ones that consumers would have to pay, however.

“Although there is a cost to the vaccine, it is not borne by insured patients,” Powell said. “The Affordable Care Act requires that the MMR vaccine be fully covered without patient cost sharing in its provisions requiring the coverage of preventive services.”

It’s long been clear that the risk-benefit calculation from a health and scientific perspective comes down heavily in favor of the vaccine. Measles kills approximately one in 1,000 to 3,000 cases, and it causes brain damage from encephalitis in one in 1,000 cases, not including the individuals who develop pneumonia or other complications. The vaccine, by contrast, most commonly causes a fever, joint pain or mild rash and can cause a fever-caused seizure in one of 3,000 doses, a low platelets count (that usually resolves on its own) in one of 30,000 doses, or, in extremely rare situations, a severe allergic reaction in one in a million doses.

The cost-benefit calculation in dollars and cents looks pretty similar.