Evaluating the costs and benefits of national surveillance and response system
- Back ground
Doc reference: WHO/CDS/EPR/LYO/2005.25
Author: Martha Anker
Project of WHO the department of Epidemic and Pandemic Alert and Response (EPR)
Why: need evidence to show that early warning and response to epidemic-rone infectious disease is cost effective
- International Health Regulation
What it is? IHR are a set of practices agreed to by countries with the aim of preventing the international spread of disease using measures that interfer as little as possible with internation trade and travel
Origine of this paper: countries need to upgrade surveillance system to answer IHR 2005 request
- Scope and design of studies
3.1 a. should there be seperate studies of costs and benefits? - yes
3.1 b. cost-effectiveness, cost utility or cost benefit? - no evidence on the quantified benefits of surveillance and response syst. Do cost and benefit seperately
3.2. What should be included in a surveillance and response system
Objectives, project context
prevent serious epidemic-prone disease
Specific programme objectives, such as eradication or elimination
reporting frequence: monthly, weekly.
reporting system: compulsory or sentinel
With/o laboratory test
Vertical or integrated
Geographic zone
cost surveillance and response seperately or together
If targeting the surveillance system, can cost only surveillance
If cost outbreak response, we need to include surveillance
Elements or activities to be included
Surveillance system components
6 core function of surveillance system
Case registration
Case confirmation (including verification orf rumours )
Reporting
data analysis and interpretation
feedback and dissemination
Support elements for surveillance
standards, norms and guidelines
Training
supervision
Resource (including staff, laboratories and other resources)
inclusion criterion
Any activity is one of the six core acivities or four support elements or its main purpose is surveillance
ex. diagnose and treat patients, sending a specimen to the laboratory for testing or the time the doctor takes to recored the diagnosis, should not be counted as surveillance. because they sould be carried out in any case as part of the diagnosis and treatment of patients.
Case detection
Response system components
Main activities
confirming the diagnoses
Active case finding
Taking clinical and environmental samples
analysing and interpreting data
formulating and testing hypotheses about sources of exposure and modes of transmission
Main control measures
case management, including infecion control
contact tracing
analysis and dissemination of laboratory information
Environmental control measures
mass prevention
behaviour modification
communication
social mobilization
Inclusion criterion
Any activities, of which the main objectives are to investigate or control outbreaks
For routine health service: reporting of health events to the next higher level should be included.
For routine health service: activities in which health staff participate in outbreak investigation and emergency planning for outbreaks should included
3.3 Perspective
case by case
national. or local, or international? case by case
3.4 Study design
Baseline comparator ? yes. It is needed
To evaluate a new feature, use current situation.
New features are in place already, compare with previous situation
Comapre the whole surveillance and response system with respect to the null system
Restrospective, prospective or future scenario data? Depends.
3.5 Time period to use
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