COVID-19 Focused Cost-benefit Analysis of Public Health Emergency Preparedness and Crisis Response Programs

Music City Center 

Background
The United States (US) Centers for Disease Control and Prevention (CDC) Division of State and Local Readiness (DSLR) plays a crucial role in supporting state, local, and territorial governments through the Public Health Emergency Preparedness (PHEP) cooperative agreement program. During the COVID-19 pandemic, CDC's DSLR extended additional financial support to bolster response efforts through the Public Health Crisis Response (PHCR) cooperative agreement. We used data on PHEP and PHCR program implementation from within the population of funded recipients and external measures of COVID-19 response effectiveness to assess the cost and benefit of the PHEP and the PHCR programs on the COVID-19 response through a cost-benefit analysis.

Methods
Annual workplans and progress reports provided significant components of the program implementation information from both PHEP and PHCR; NLP was used to create structured program implementation features. The relationship between recipient reported PHEP and PHCR implementation features (activities and outputs planned or achieved vs. not planned or achieved) and externally measured outcomes that represent an effective response to the COVID-19 pandemic was assessed using path analysis and lasso regression models. Outcomes assessed included time to implement control measures, availability of COVID-19 therapeutics, COVID-19 tests and vaccines administered, and hospital bed availability. The benefits associated with specific implementation decisions such as funding allocation decisions and planned activities and outputs were estimated for statistically significant relationships.

Results
Activities and outputs were associated with faster non-essential business closures, earlier implementation of mask mandates, more frequent reporting to the public, administering more COVID-19 tests, and maintaining a larger availability of hospital beds and COVID-19 therapeutics during surges. Additionally, funding allocations to four of the six preparedness capability domain areas, countermeasures and mitigation, incident management, information management, and surge management, were associated with the ability to administer more COVID-19 tests and vaccines and maintain increased hospital bed availability during peak surges.

Conclusions
PHEP and PHCR funding had measurable positive effects on recipients' ability to respond to the COVID-19 pandemic effectively. Ongoing efforts in specific areas of public health emergency preparedness will improve future responses to COVID-19-like events.

public health emergency preparedness

cost-benefit analysis

program evaluation

COVID-19

PHEP