Disasters increasingly occur over the world and are becoming more challenging for society. ^{Reference ten Have, O’Mathúna, Dranseika and Gordijn1} Investments in disaster risk reduction (DRR) reduce disaster losses and help strengthen economic, social, and environmental capacities. ^{Reference Kawasaki and Rhyner2} Conducting DRR measures can be cost-effective due to saving lives and preventing economic damage, and saving recovery costs. ³

Governments need to use economic evaluation approaches to design their interventions in terms of the main financial sources allocated to DRR. ^{Reference Watson, Caravani and Mitchell4} Accordingly, the study of DRR financing in 5 countries showed that even low-income countries can prioritize DRR measures by managing the allocated financial resources for disaster management in the national budgets. Economic evaluation methods such as cost-effectiveness analysis can help health policy-makers understand the importance of allocating resources to prevention interventions. ^{Reference Kellett, Caravani and Pichon5}

Reducing disaster casualties and destructions in the critical infrastructure of the health sector can be considered a crucial measure ^{Reference Maly and Suppasri6} ; however, long-term DRR planning for the health sector has not been considered by public health systems due to financial resource limits. ^{Reference Dar, Buckley and Rokadiya7} The economic evaluation of different phases of disaster management (mitigation, preparedness, response, and recovery) can describe the importance of investments in disaster prevention programs which are cost-effective, especially in disaster-prone regions. ^{Reference Ishiwatari and Surjan8} To our knowledge, a few studies have been conducted to investigate the economic evaluation methods/approaches in the field of health in disasters. Thus, the present study is aimed to identify the studies which applied economic evaluation approaches/methods for evaluating the economic costs of disasters. Accordingly, the knowledge gaps of economic research in the field of disaster health management are recognized.

Results

A total of 1934 references were identified through the initial search. After the screening process, 8 articles met the inclusion criteria and were selected for analysis (Figure 1). The final articles were described based on the publication date, setting, disaster type, disaster management phase, health dimensions, and economic approaches (Tables 1 and 2).

Figure 1. Articles screening and selections flowchart.

Table 1. Characteristics of the final selected articles

Table 2. Frequency of setting, health dimension, economic evaluation, and disaster management phases

Economic Evaluation Approaches/Methods

The economic evaluation approaches/methods in the context of disasters have been conducted in the forms of cost-effectiveness analysis, damage/economic loss assessments, economic modeling/map, and behavioral economic evaluation.

Cost-effectiveness analysis

A few studies reported the performance of cost-effectiveness analysis in the field of disaster health management. For example, the study comparing cost-effectiveness analysis of emergency medical team (EMT) and search and rescue (SAR) deployment showed that the deployments of both SAR and EMT are highly expensive, and their successes depends on the time they require to be operational. EMTs deployments were determined by the lack of detailed clinical information and assessments of response due to the insufficient reliable data and reports shared by internal agencies. SAR deployments were specified by limited lives served as the result of long-distance travel, response time, and late arrival in affected regions. ^{Reference Bartolucci, Walter and Redmond10} In addition, the study of comparison between a stepped care case-finding intervention (SC) and moderate-strength single-level intervention as the usual care (UC) after Hurricane Sandy found the 10-y incremental cost-effectiveness of each intervention for patients with post-traumatic stress disorder (PTSD). Comparing the incremental cost-effectiveness of SC and UC showed that SC intervention is more cost-effective for patients with PTSD after a natural disaster. ^{Reference Cohen, Tamrakar and Lowe11}

Damage/economic loss assessments

The damage or economic loss assessment studies were conducted after disasters. For instance, the economic damage of floods in the Sampang Regency in Indonesia was estimated by Tangible Damage Assessment using Averting Behavior Method. Authors estimated that the flood losses value is Rp 5,881,948,800 which consists of structural and household property losses, health (medical treatment) and education losses, as well as vehicle damage and income reduction. ^{Reference Prihantini12} Furthermore, the relationship between Hurricanes Katrina/Rita exposure and mental health resilience in terms of vulnerability conditions as well as the economic cost of poor mental health days followed by exposure to natural disasters were measured through monthly time series and negative binomial regression. The authors found that the poor mental health count is sensitive to the intensity of hurricanes by a factor of 1.06 for every billion (US $) dollars of destructions added for the exposed people, and by a factor of 1.08 for single mothers. Single mothers suffered more than $130 million in the loss of productivity from added stress and disability after disasters. ^{Reference Zahran, Peek and Snodgrass13}

Economic modeling/mapping

The economic modeling or mapping studies have been conducted based on the scenarios which likely occur in the future. For example, the dynamic inequalities route map of the imbalanced economic recovery was provided using the map for the economic scenario of flooding in London in 2020. Accordingly, the economy of London would recover over 70 mo by using a proportional rationing scheme with the assumption of 40% primary loss to service sectors, 50% initial loss to labor, and 10-30% to other sectors loss. The modeling with various labor recovery paths showed that conducting the previous policies in health-care and transportation recovery is necessary for economic recovery after disasters. ^{Reference Li, Crawford-Brown and Syddall14} In a retrospective study, analysis of disaster and economic data between 1970 and 2010 to examine the disasters impacts on economic growth at country/region level was conducted using a random parameter modeling approach. The significant risk factors which vary for countries/regions included disaster intensity based on homelessness and deaths as well as economic properties such as accessibility to trade. Flood was found as the most destructive disaster affecting economic growth of many countries/regions. ^{Reference Mukherjee and Hastak15} In addition, the study of comparing the socio-economic vulnerability conditions of villages in Aceh province, Indonesia, was conducted to map the villages based on their social-economic vulnerabilities. The 6512 villages were grouped into 3 clusters using the Genetic-K Prototype algorithm based on 30 variables of socio-economic vulnerability. The first cluster of villages had the best socio-economic indicators and experienced at least 1 disaster. The second and third clusters included villages with the least telecommunication and information supplies and minimum access to important facilities and areas. This cluster had the characteristics which kept rural people away from disaster preparedness measures. ^{Reference Nooraeni, Yudho and Pramana16}

Behavioral economic

Behavioral economic can provide an economics-psychology framework to understand how people behave during the phases of disaster management. For example, the study of behavioral economics in disasters recognized the decision-making biases relevant to disaster preparedness and response. The authors reported that behavioral economics interventions can respond to disaster preparedness biases through 2 types of interventions including communication and programmatic interventions. Communication interventions are low-cost and can be merged into the current efforts. Programmatic interventions need the adoption of programs, policies, and efforts on human resources. ^{Reference Linnemayr, O’Hanlon and Uscher-Pines17}