Cost-Effectiveness Considerations for Disease Intervention

Abstract

A s part of the American Rescue Plan Act of 2021, the federal government announced more than 1 billion dollars in new funding to support the disease intervention specialist (DIS) workforce. 1 As this funding is dispersed, state and local public health officials will decide how to best use it to advance public health goals, given budget and workforce constraints. Decisions on how to develop and implement a program or intervention are made in consideration of these resource limitations, and cost-effectiveness analysis (CEA) provides a framework for guiding this decision-making process.Cost-effectiveness analysis is motivated by the need to maximize some health outcome given a limited set of resources or, conversely, to minimize the costs to achieve a particular health goal. 2 In essence, CEA quantifies trade-offs between the costs and benefits of a health intervention. A core concept in CEA is the idea of opportunity costs, or the value of potential alternative uses of a resource. 3 We typically want to avoid using limited resources on an activity if an alternative use of these resources could result in larger health gains. Costs of an intervention are measured in dollars, and benefits are measured in terms of a health outcome of interest. The costs and benefits of each intervention are then compared, and interventions that yield greater health gains per dollar spent should thus be prioritized, all else being equal.Disease intervention specialist may engage in a variety of different activities that go well beyond sexually transmitted infection (STI) partner notification. The overall benefits of having a strong DIS workforce are broad and difficult to quantify. Rather than estimating the full benefits of DIS, this commentary will focus on using CEA methods to help decision makers prioritize DIS activities.

The Epidemiology and Costs of Disease Intervention Specialist Retention

“…Disease Intervention Specialist output can be measured using cases investigated, patients treated, and partners notified, but DISs do more, such as patient navigation to health insurance and social services and provider education 5,6 . Quantifying and including (or excluding) these outcomes would impact the cost-effectiveness of DIS and by extension DIS retention 7 . Beyond DIS output, quantifying the health impact of DIS activities presents additional challenges when also considering DIS retention.…”

“…5,6 Quantifying and including (or excluding) these outcomes would impact the cost-effectiveness of DIS and by extension DIS retention. 7 Beyond DIS output, quantifying the health impact of DIS activities presents additional challenges when also considering DIS retention.…”

Creating a Sexually Transmitted Infection Disease Intervention Workforce for the 21st Century

“…35 Another method to assess the impact of DIS work is through cost-effectiveness analyses, which can aid in a prioritization of disease intervention activities. 36 As previously noted, various contextual factors that are often interconnected can impact disease intervention activities, and this relationship is often bidirectional. A recent analysis of state law found that states authorize or require disease investigation for communicable disease or sexually STIs to varying degrees.…”

“…In addition, measures may not include what was missed by syphilis partner service interviews (e.g., unnamed partners, partners not reached, partners treated without DIS contact), and many DIS activities are not included in existing metrics 35 . Another method to assess the impact of DIS work is through cost-effectiveness analyses, which can aid in a prioritization of disease intervention activities 36 …”