Evidence of the Cost-Efficiency of Scale as seen in Polio Vaccination and Surveillance Costs

Hagedorn, Brittany; Mercer, Laina D.; Chabot-Couture, Guillaume

doi:10.1101/654350

Cited by 2 publications

(2 citation statements)

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“…Tebbens [8] examined the total cost of the global polio laboratory network (including both environmental and case surveillance) and concluded that true total costs were higher than budgeted for, while Hagedorn et al [9] found that there were economies of scale for surveillance programs. Given this, cost estimates for a future typhoid ES system must consider costs of implementation not for a single sampling site, but when expanded to cover large geographic regions and higher volumes.…”

Section: Introductionmentioning

confidence: 99%

Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries

Hagedorn

Zhou²,

Fagnant-Sperati³

et al. 2023

PLOS Glob Public Health

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The typhoid conjugate vaccine is a safe and effective method for preventing Salmonella enterica serovar Typhi (typhoid) and the WHO’s guidance supports its use in locations with ongoing transmission. However, many countries lack a robust clinical surveillance system, making it challenging to determine where to use the vaccine. Environmental surveillance is one alternative approach to identify ongoing transmission, but the cost to implement such a strategy is previously unknown. This paper estimated the cost of setting up and operating an environmental surveillance program for thirteen protocols that are in development, including thirteen cost components and twenty-seven pieces of equipment. Unit costs were obtained from research labs involved in protocol development and equipment information was obtained from manufacturers and the expert opinion of individuals in participating labs. We used Monte Carlo simulations to estimate the costs and the input parameters were modeled as distributions to incorporate the uncertainty. Total costs per sample including setup, overhead, and operational costs, range from $357–794 at a scale of 25 sites to $116–532 at 125 sites. Operational costs (ongoing expenditures) range from $218–584 per sample at a scale of 25 sites to $74–421 at 125 sites. Eleven of the thirteen protocols have operational costs below $200, at this higher scale. Protocols with higher up-front equipment costs benefit more from scale efficiencies and sensitivity analyses show that laboratory labor, processes, and consumables are the primary drivers of uncertainty. At scale, environmental surveillance for typhoid may be affordable (depending on the protocol, scale, and geographic context), though cost will need to be considered alongside future evaluations of test sensitivity. Opportunities to leverage existing infrastructure and multi-disease platforms may be necessary to further reduce costs.

show abstract

Section: Introductionmentioning

confidence: 99%

Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries

Hagedorn

Zhou²,

Fagnant-Sperati³

et al. 2023

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…Previous work has examined the total cost of the global polio laboratory network (including both environmental and case surveillance) and suggested that true total costs were higher than budgeted 8 , but they are also subject to economies of scale 9 . Given this, cost estimates for a future typhoid ES system must consider costs of implementation not for a single sampling site, but when expanded to cover large geographic regions and higher volumes.…”

Section: Introductionmentioning

confidence: 99%

The cost of building an environmental surveillance system for typhoid

Hagedorn

Zhou

Fagnant-Sperati

et al. 2021

Preprint

Self Cite

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Introduction. The typhoid conjugate vaccine is a safe and effective method for preventing Salmonella enterica serovar Typhi (typhoid) and the WHO's guidance supports its use in locations with ongoing transmission. However, many countries lack a robust clinical surveillance system, making it challenging to determine where to use the vaccine. Environmental surveillance is an alternative approach to identify ongoing transmission, but the cost to implement such a strategy is previously unknown. Methods. We estimated the cost of an environmental surveillance program for thirteen potential protocols. Unit costs were obtained from research labs involved in protocol development and equipment information was obtained from manufacturers and expert opinion. The cost model includes thirteen components and twenty-seven pieces of equipment. We used Monte Carlo simulations to project total costs. Results. Total costs per sample including setup, overhead, and operational costs, range from $357-794 at a scale of 25 sites to $116-532 at 125 sites. Operational costs (ongoing expenditures) range from $218-584 per sample (25 sites) to $74-421 (125 sites). Eleven of the thirteen protocols have operational costs below $200 at this higher scale. Protocols with high up-front equipment costs benefit more from scale efficiencies. Sensitivity analyses show that laboratory labor, process efficiency, and the cost of consumables are the primary drivers of cost. Conclusion. At scale, environmental surveillance may be affordable, depending on the protocol chosen and the geographic context. Costs will need to be considered along with protocol sensitivity. Opportunities to leverage existing infrastructure and multi-disease platforms may be necessary to further reduce costs.

show abstract

Evidence of the Cost-Efficiency of Scale as seen in Polio Vaccination and Surveillance Costs

Cited by 2 publications

References 19 publications

Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries

Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries

The cost of building an environmental surveillance system for typhoid

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