Quantifying the Cost of Measles Outbreak in the U.S. and How Costs Scale with Outbreak Size

Importance: In 2025, the United States experienced the largest number of measles cases since its elimination in 2000. These outbreaks require extensive public health responses to mitigate, consume substantial hospital resources, and impose an economic and financial burden on state and federal budgets. Objective: To review evidence on the costs of measles outbreaks in the United States between 2000 and 2025, as well as to examine how costs scale with outbreak size to better model the costs associated with measles outbreaks. Evidence Review: We conducted a literature review using PubMed to identify studies published between January 1, 2000, and October 7, 2025, using terms related to measles cases, costs, and outbreak response, across all 50 states in the United States of America. Additional publicly available reports beyond the PubMed published literature were identified through a review of official CDC and state health department reports. Findings: A total of 120 articles were screened, 33 underwent full text review, and data were extracted from 19 articles, yielding outbreak relevant costs in 18 different states. Eight additional reports in the gray literature were identified. Outbreak size ranged from 1 to 802 cases. Average outbreak cost per case was estimated at $43,203.65, while the average cost per contact was $443.46. Average cost per case varied from $33,415.75 from the medical provider perspective to $58,591.50 when including public health response costs. The incremental cost per case was estimated at $16,197.13 per additional measles case, after accounting for the fixed costs of initiating a public health response. Conclusion and Relevance: Measles outbreaks in the U.S. continue to re-emerge and impose significant financial and public health burden. These outbreaks are largely preventable through inexpensive and highly effective measles vaccination paired with system-level preparedness for effective containment. Since fixed response costs for any outbreak can be costly, our estimates provide improved data on how costs of measles outbreaks scale with outbreak size by isolating incremental costs associated incident new cases, as well as incident contacts, for use alongside budgetary planning and modeled risk assessments.