Quantifying the Cost of Measles Outbreak in the U.S. and How Costs Scale with Outbreak Size

  1. Salin Sriudomporn
  2. Bryan Patenaude

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Abstract

Importance

In 2025, the United States experienced the largest number of measles cases since its elimination in 2000. These outbreaks require extensive public health responses to mitigate, consume substantial hospital resources, and impose an economic and financial burden on state and federal budgets.

Objective

To review evidence on the costs of measles outbreaks in the United States between 2000 and 2025, as well as to examine how costs scale with outbreak size to better model the costs associated with measles outbreaks.

Evidence Review

We conducted a literature review using PubMed to identify studies published between January 1, 2000, and October 7, 2025, using terms related to measles cases, costs, and outbreak response, across all 50 states in the United States of America. Additional publicly available reports beyond the PubMed published literature were identified through a review of official CDC and state health department reports.

Findings

A total of 120 articles were screened, 33 underwent full text review, and data were extracted from 19 articles, yielding outbreak relevant costs in 18 different states. Eight additional reports in the gray literature were identified. Outbreak size ranged from 1 to 802 cases. Average outbreak cost per case was estimated at $43,203.65, while the average cost per contact was $443.46. Average cost per case varied from $33,415.75 from the medical provider perspective to $58,591.50 when including public health response costs. The incremental cost per case was estimated at $16,197.13 per additional measles case, after accounting for the fixed costs of initiating a public health response.

Conclusion and Relevance

Measles outbreaks in the U.S. continue to re-emerge and impose significant financial and public health burden. These outbreaks are largely preventable through inexpensive and highly effective measles vaccination paired with system-level preparedness for effective containment. Since fixed response costs for any outbreak can be costly, our estimates provide improved data on how costs of measles outbreaks scale with outbreak size by isolating incremental costs associated incident new cases, as well as incident contacts, for use alongside budgetary planning and modeled risk assessments.

Article activity feed

  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17627798.

    This paper examines the economic burden of measles outbreaks in the United States from 2000 to 2025, aiming to connect outbreak cost evidence as measles re-emerges in pockets of under vaccinated communities. The authors compiled outbreak cost data from 18 peer-reviewed studies and eight gray-literature reports, adjust all figures to 2024 USD, and perform a regression analysis to estimate the fixed and incremental costs of responding to measles cases. Results showed that measles outbreaks are financially significant regardless of size, with an estimated fixed cost of approximately $244,480 simply to initiate a response and an incremental cost of about $16,200 per additional case. Across events, the average cost per case was $43,204, and average cost per contact was $443.

    Overall, this manuscript provides a novel and policy-relevant contribution. The study's comprehensive time frame captures recent measles resurgence, including the sizable 2025 outbreaks, which make the findings directly relevant to current public-health challenges. The paper also effectively standardizes cost estimates to a single year, which improves interpretability across decades. Importantly, the regression model provides public-health agencies with a simple budgeting framework that clearly communicates the economic consequences of delayed vaccination and surveillance.

    Dispute authors mentioned 4 major issues inside discussion section, one other major issue is that the results do not directly demonstrate or quantify the claim that maintaining high measles vaccination coverage is the most cost-saving public health investment. The study's regression model estimates outbreak-related costs and shows that fixed response costs are high even for small outbreaks. However, it does not include a comparative cost-effectiveness analysis between prevention and response expenditures. Therefore, the conclusion that vaccination "remains one of the most cost-saving investments" is more inferential than evidence-based within the presented data. To strengthen this claim, the authors could incorporate a sensitivity or scenario analysis estimating how different vaccination coverage levels would translate into avoided outbreak costs. Without such an analysis, the conclusion, while plausible and aligned with existing literature, is not directly supported by the study's empirical findings.

    Minor issues include visualization, adding one more figure showing how the fitness of the 33 different data and the given linear regression, like a scatter plot, which helps communicate the linear model visually to non-technical readers. In addition, for convenience and readability, data in table 2 could rearrange from largest total cost to lowest total cost.

    Overall, this paper requires only minor revision. The authors should re-examine the conclusion that high measles vaccination coverage remains one of the most cost-saving public health investments, as the current analysis does not directly compare vaccination costs with outbreak response expenditures. In addition, to further strengthen the study, the authors could consider applying large language models to improve data collection and standardization from gray-literature sources.

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  2. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17627836.

    This paper examines the economic burden of measles outbreaks in the United States from 2000 to 2025, aiming to connect outbreak cost evidence as measles re-emerges in pockets of under vaccinated communities. The authors compiled outbreak cost data from 18 peer-reviewed studies and eight gray-literature reports, adjust all figures to 2024 USD, and perform a regression analysis to estimate the fixed and incremental costs of responding to measles cases. Results showed that measles outbreaks are financially significant regardless of size, with an estimated fixed cost of approximately $244,480 simply to initiate a response and an incremental cost of about $16,200 per additional case. Across events, the average cost per case was $43,204, and average cost per contact was $443.

    Overall, this manuscript provides a novel and policy-relevant contribution. The study's comprehensive time frame captures recent measles resurgence, including the sizable 2025 outbreaks, which make the findings directly relevant to current public-health challenges. The paper also effectively standardizes cost estimates to a single year, which improves interpretability across decades. Importantly, the regression model provides public-health agencies with a simple budgeting framework that clearly communicates the economic consequences of delayed vaccination and surveillance.

    Dispute authors mentioned 4 major issues inside discussion section, one other major issue is that the results do not directly demonstrate or quantify the claim that maintaining high measles vaccination coverage is the most cost-saving public health investment. The study's regression model estimates outbreak-related costs and shows that fixed response costs are high even for small outbreaks. However, it does not include a comparative cost-effectiveness analysis between prevention and response expenditures. Therefore, the conclusion that vaccination "remains one of the most cost-saving investments" is more inferential than evidence-based within the presented data. To strengthen this claim, the authors could incorporate a sensitivity or scenario analysis estimating how different vaccination coverage levels would translate into avoided outbreak costs. Without such an analysis, the conclusion, while plausible and aligned with existing literature, is not directly supported by the study's empirical findings.

    Minor issues include visualization, adding one more figure showing how the fitness of the 33 different data and the given linear regression, like a scatter plot, which helps communicate the linear model visually to non-technical readers. In addition, for convenience and readability, data in table 2 could rearrange from largest total cost to lowest total cost.

    Overall, this paper requires only minor revision. The authors should re-examine the conclusion that high measles vaccination coverage remains one of the most cost-saving public health investments, as the current analysis does not directly compare vaccination costs with outbreak response expenditures. In addition, to further strengthen the study, the authors could consider applying large language models to improve data collection and standardization from gray-literature sources.

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  3. Version published to 10.1101/2025.10.24.25338724 on medRxiv