Abstract
BackgroundEffective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa.Methodology/Principal FindingsTo assess the impact of the IDSR in Africa, we used pre- and post- IDSR meningococcal meningitis surveillance data from Burkina Faso (1996–2002 and 2003–2007). IDSR implementation was correlated with a median reduction of 2 weeks to peak of outbreaks (25th percentile 1 week; 75th percentile 4 weeks). IDSR was also correlated with a reduction of 43 meningitis cases per 100,000 (25th–40: 75th-129). Assuming the correlations between reductions in time to peak of outbreaks and cases are related, the cost-effectiveness of IDSR was $23 per case averted (25th-$30; 75th - cost saving), and $98 per meningitis-related death averted (25th-$140: 75th – cost saving).Conclusions/SignificanceWe cannot absolutely claim that the measured differences were due to IDSR. We believe, however, that it is reasonable to claim that IDSR can improve the cost-effectiveness of public health surveillance.
Highlights
More than 1.5 million children die each year in sub-Saharan Africa, from diarrhea, malaria, measles, meningitis, respiratory infections, yellow fever, and HIV/AIDS [1,2,3,4,5,6]
The nature of disease surveillance systems makes it impossible to have a randomly controlled experiment to measure the impact of Integrated Disease Surveillance and Response (IDSR) on public health outcomes
Health outcomes and effectiveness measures Based on our definition of outbreaks (10 per 100,000 – see earlier), we identified 105 outbreaks before adoption of IDSR and 86 after adoption of IDSR (Table S2)
Summary
More than 1.5 million children die each year in sub-Saharan Africa, from diarrhea, malaria, measles, meningitis, respiratory infections, yellow fever, and HIV/AIDS [1,2,3,4,5,6]. The resulting deaths and the associated economic costs to society could be reduced if timely detection and control measures are implemented [11,12,13]. In response to this problem, in 1998, countries in the World Health Organization (WHO) African region adopted a regional strategy named Integrated Disease Surveillance and Response (IDSR) [14– 16, Table S1]. The goal of IDSR is to integrate a number of surveillance systems, both existing and newly formed This integration should encompass all levels of public health (from the basic district-level through to the national level), and should achieve efficiencies by avoiding duplication of efforts. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa
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