Ebola model parameter range and distribution.

In this paper, we examine the cost effectiveness of investment in personal protective equipment (PPE) for protecting health care workers (HCWs) against two infectious diseases: Ebola virus and methicillin-resistant Staphylococcus aureus (MRSA). This builds on similar work published for COVID-19 in 2020. We developed two separate decision-analytic models using a payer perspective to compare the costs and effects of multiple PPE use scenarios for protection of HCW against Ebola and MRSA. Bayesian multivariate sensitivity analyses were used to consider the uncertainty surrounding all key parameters for both diseases. We estimate the cost to provide adequate PPE for a HCW encounter with an Ebola patient is $13.04, which is associated with a 97% risk reduction in infections. The mean incremental cost-effectiveness ratio (ICER) is $3.98 per disability-adjusted life year (DALY) averted. Because of lowered infection and disability rates, this investment is estimated to save $132.27 in averted health systems costs, a financial ROI of 1,014%. For MRSA, the cost of adequate PPE for one HCW encounter is $0.88, which is associated with a 53% risk reduction in infections. The mean ICER is $362.14 per DALY averted. This investment is estimated to save $20.18 in averted health systems costs, a financial ROI of 2,294%. In terms of total health savings per death averted, investing in adequate PPE is the dominant strategy for Ebola and MRSA, suggesting that it is both more costly and less clinically optimal to not fully invest in PPE for these diseases. There are many compelling reasons to invest in PPE to protect HCWs. This analysis examines the economic case, building on previous evidence that protecting HCWs with PPE is cost-effective for COVD-19. Ebola and MRSA scenarios were selected to allow assessment of both endemic and epidemic infectious diseases. While PPE is cost-effective for both conditions, compared to our analysis for COVID-19, PPE is relatively more cost-effective for Ebola and relatively less so for MRSA. Further research is needed to assess shortfalls in the PPE supply chain identified during the COVID-19 pandemic to ensure an efficient and resilient supply in the face of future pandemics.

本研究针对埃博拉病毒（Ebola virus）与耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus, MRSA）两种传染病，探讨为医护人员（health care workers, HCWs）配备个人防护装备（personal protective equipment, PPE）的投资成本效益。本研究基于2020年针对新型冠状病毒肺炎（COVID-19）发表的同类研究拓展而来。
我们采用支付方视角构建了两套独立的决策分析模型（decision-analytic models），用于对比多种PPE使用场景下，医护人员防护上述两种传染病的成本与健康产出。针对两种传染病的全部关键参数不确定性，我们采用贝叶斯多变量敏感性分析（Bayesian multivariate sensitivity analyses）开展评估。
经测算，单次接诊埃博拉患者时为医护人员配备充足PPE的成本为13.04美元，可将感染风险降低97%。其平均增量成本效果比（incremental cost-effectiveness ratio, ICER）为每挽回1个伤残调整生命年（disability-adjusted life year, DALY）需投入3.98美元。由于感染与伤残率得以有效控制，该投资预计可节省132.27美元的医疗系统成本，财务投资回报率高达1014%。
针对MRSA场景，单次接诊为医护人员配备充足PPE的成本为0.88美元，可将感染风险降低53%。其平均ICER为每挽回1个DALY需投入362.14美元。该投资预计可节省20.18美元的医疗系统成本，财务投资回报率高达2294%。
从每挽回1例死亡对应的总健康储蓄来看，为埃博拉与MRSA防护投资充足PPE均为优势策略，这意味着若未为这两类传染病全额投资PPE，不仅会增加医疗成本，临床疗效也将劣于全额投资方案。
为医护人员配备PPE的必要性有据可循，本分析则从经济学层面验证了这一点，延续了此前关于PPE防护医护人员对COVID-19具备成本效益的研究结论。本次选取埃博拉与MRSA场景，旨在实现对地方性与流行性传染病防护策略的评估。
尽管针对两种传染病，PPE均具备成本效益，但相较于我们针对COVID-19的分析结果，埃博拉场景下PPE的成本效益相对更高，而MRSA场景下则相对更低。
未来仍需开展进一步研究，以评估新冠疫情期间暴露的PPE供应链短板，确保在未来大流行背景下，PPE供应链具备高效性与韧性。