Valuing Health Surveillance as an Information System: Interdisciplinary Insights

Abstract

The economic evaluation of health surveillance systems and of health information is a methodological challenge, as for information systems in general. Main present threads are considering cost-effectiveness solutions, minimizing costs for a given technically required output, or cost-benefit analysis, balancing costs with economic benefits of duly informed public interventions. The latter option, following a linear command-and-control perspective, implies considering a main causal link between information, decision, action, and health benefits. Yet, valuing information, taking into account its nature and multiple sources, the modalities of its processing cycle, from production to diffusion, decentralized use and gradual building of a shared information capital, constitutes a promising challenge. This work proposes an interdisciplinary insight on the value of health surveillance to get a renewed theoretical framework integrating information and informatics theory and information economics. The reflection is based on a typological approach of value, basically distinguishing between use and non-use values. Through this structured discussion, the main idea is to expand the boundaries of surveillance evaluation, to focus on changes and trends, on the dynamic and networked structure of information systems, on the contribution of diverse data, and on the added value of combining qualitative and quantitative information. Distancing itself from the command-and-control model, this reflection considers the behavioral fundaments of many health risks, as well as the decentralized, progressive and deliberative dimension of decision-making in risk management. The framework also draws on lessons learnt from recent applications within and outside of health sector, as in surveillance of antimicrobial resistance, inter-laboratory networks, the use of big data or web sources, the diffusion of technological products and large-scale financial risks. Finally, the paper poses the bases to think the challenge of a workable approach to economic evaluation of health surveillance through a better understanding of health information value. It aims to avoid over-simplifying the range of health information benefits across society while keeping evaluation within the boundaries of what may be ascribed to the assessed information system.

Evaluation of the French surveillance system for epidemiological surveillance of antimicrobial resistance in the community and nursing homes

“…the need to strengthen dissemination of the results towards local/regional actors, hence increasing the value of the information coming from surveillance activities, an aspect which is often overlooked in surveillance systems. 23 Beyond the recommendations coming from the evaluation, the OASIS tool itself could easily be applied to other countries or systems willing to achieve similar evaluation objectives.…”

Evaluating the Integration of One Health in Surveillance Systems for Antimicrobial Use and Resistance: A Conceptual Framework

“…Complex OH surveillance systems, such as surveillance systems for AMR and AMU may not produce direct economic benefits in the short-term because they may not lead immediately to specific interventions. Intellectual and social capital benefits, which are difficult to capture through quantitative metrics in the short-term, may lead to large benefits in the long-term ( 46 ). However, these studies could be useful as a starting point for structuring the evaluation of health and economic impact of the integrated OH surveillance systems for AMR and AMU.…”

Engaging Stakeholders in the Design of One Health Surveillance Systems: A Participatory Approach

“…The French system's greater stabilization, in terms of information production, allowed stakeholders to better focus on its use and impact. This user-based vision of health surveillance value and required improvement appears to be a quite recent concern, with methodologies that remain to be elaborated ( 13 ). Hence, participants proved able to develop original insights on the operationalization of the One Health concept in surveillance.…”

“…Surveillance mobilizes networks of stakeholders with specific roles and missions subject to their own constraints. It produces information for different categories of beneficiaries with different expectations ( 13 ). Although surveillance is most often associated with positive impacts (improvement of the prevention and management of health events), it can have negative repercussions for certain stakeholders (destruction of food products following the detection of health hazards, slaughtering of animals following the detection of certain diseases).…”