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The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics.

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Objectives: To compare the benefit-risk and medical costs of rivaroxaban low dosage (15mg) versus vitamin-K antagonists (VKA) for non-valvular (NV) atrial fibrillation (AF) in real-life setting. MethOds: All new users of anticoagulant for NVAF in 2013 or 2014 were identified and followed for 1 year in the French SNIIRAM nationwide claims database. NFAV patients were those with long-term disease registration, hospitalisation, or procedure for AF, without rheumatic valve disease or valve replacement. Patients with rivaroxaban 15mg were 1:1 matched with those with VKA, on gender, age, date of the first drug dispensing, and high-dimensional propensity score, including arterial thrombosis and bleeding risk factors. Relative risk (RR) of the composite criterion (hospitalisation with primary diagnosis for stroke and systemic embolism, major bleeding, and death) during drug exposure was estimated using Cox proportional hazard risk model. Medical costs were calculated according to the collective perspective for the same period. Results: Of 220,011 incident anticoagulant users treated for NVAF in 2013 or 2014, 23,356 patients with rivaroxaban 15mg were matched with the same number of VKA patients. The risk of the composite was significantly lower with rivaroxaban 15mg than VKA (RR: 0.89 [CI95%: 0.84 to 0.94]). The mean cost per patient was higher for anticoagulants and drugs for AF (€ 688 vs € 97), but lower for lab tests (€ 196 vs € 464), transports (€ 216 vs € 289), nursing acts (€ 677 vs 962€), medical visits (€ 848 vs € 952), specific AF hospitalisations (€ 892 vs € 1,066), and total medical cost (€ 8,337 vs € 10,010). cOnclusiOns: The study shows that rivaroxaban 15mg for NVAF is cost-saving compared to VKA with a better benefit-risk in real-life setting and a 17% lower medical cost for the French collective perspective.