Quantifying the cost of measles outbreaks in the U.S. and how costs scale with outbreak size

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. We conducted a literature review using PubMed as well as official CDC and state health department reports to identify studies published between January 1, 2000, and October 7, 2025, across all 50 states. We also examined how costs scale with outbreak size. 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. Fixed costs of imitating public health responses were estimated at $297,746.94 (95% CI: $4537.86 - $590,956.02), with an incremental cost of $16,299.64 (95% CI: $15,301.96 - $17,297.32) per each additional case. The elasticity of the total costs with respect to outbreak size was estimated at 0.86 (95% CI: 0.65-1.07) 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.