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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.