Evaluating the costs and benefits of national surveillance and response system

  1. 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

  1. 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

  1. 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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