Cost-analysis of three scabies outbreaks in nursing homes in Rotterdam-Rijnmond, the Netherlands

Background

Scabies is an increasing public health concern in Western Europe, also shown through regional surveillance data in nursing homes. Besides affecting residents’ quality of life, these outbreaks impose substantial burdens on nursing home and receive considerable involvement from public health services. We analyzed the costs and identified cost-drivers of three scabies outbreaks in nursing homes in the Rotterdam-Rijnmond region (1.3 million inhabitants).

Methods

A retrospective cost-analysis using a top-down micro costing approach was conducted from the perspective of the nursing home and the public health service. A convenience sample of nursing homes outbreaks was selected, based on recency and willingness to participate. Outbreak characteristics included number of scabies cases and outbreak duration. Cost data were retrospectively collected and categorized into costs of diagnostics, medication, labor, preventive and environmental measures, travel and other.

Results

Outbreak 1 (2023) involved 12 scabies cases, lasted 7 weeks and resulted in total costs of €39.014. Outbreak 2 (2021) involved 3 cases, lasted 3 weeks and total costs were €18,665. Outbreak 3 (2024) involved at least 13 scabies cases, lasted 16 weeks and total costs were €95,616. The main cost drivers for the nursing homes were labor costs and costs for preventive and environmental measures. For the public health service, labor costs were the main contributor. Costs were underestimated due to the study method.

Conclusions

Scabies outbreaks in nursing homes are occurring more frequently and associated with substantial costs. The costs increase with longer outbreak duration and larger number of cases. These findings emphasize the importance of regional surveillance, timely diagnosis, and adequate infection prevention and control measures. Future studies should assess effectiveness of early detection and different outbreak management strategies in nursing homes.

Key messages

• This retrospective cost-analysis shows health care workers and policy makers the substantial costs of scabies outbreaks in nursing homes, that are associated with outbreak duration and number of cases.

• These results stress the importance of timely and complete implementation of scabies outbreak management measures in nursing homes and provide an overview of the cost categories in this setting.