A cost-effectiveness analysis of three components of a syndromic surveillance system for the early warning of epidemics in rural China

Abstract

BackgroundSyndromic surveillance systems (SSSs) collect non-specific syndromes in early stages of disease outbreaks. This makes an SSS a promising tool for the early detection of epidemics. An Integrated Surveillance System in rural China (ISSC project), which added an SSS to the existing Chinese surveillance system for the early warning of epidemics, was implemented from April 2012 to March 2014 in Jiangxi and Hubei Provinces. This study aims to measure the costs and effectiveness of the three components of the SSS in the ISSC project.MethodsThe central measures of the cost-effectiveness analysis of the three components of the syndromic surveillance system were: 1) the costs per reported event, respectively, at the health facilities, the primary schools and the pharmacies; and 2) the operating costs per surveillance unit per year, respectively, at the health facilities, the primary schools and the pharmacies. Effectiveness was expressed by reporting outputs which were numbers of reported events, numbers of raw signals, and numbers of verified signals. The reported events were tracked through an internal data base. Signal verification forms and epidemiological investigation reports were collected from local country centers for disease control and prevention. We adopted project managers’ perspective for the cost analysis. Total costs included set-up costs (system development and training) and operating costs (data collection, quality control and signal verification). We used self-designed questionnaires to collect cost data and received, respectively, 369 and 477 facility and staff questionnaires through a cross-sectional survey with a purposive sampling following the ISSC project. All data were entered into Epidata 3.02 and exported to Stata for descriptive analysis.ResultsThe number of daily reported events per unit was the highest at pharmacies, followed by health facilities and finally primary schools. Variances existed within the three groups and also between Jiangxi and Hubei. During a 15-month surveillance period, the number of raw signals for early warning in Jiangxi province (n = 36) was nine times of that in Hubei. Health facilities and primary schools had equal numbers of raw signals (n = 19), which was 9.5 times of that from pharmacies. Five signals were confirmed as outbreaks, of which two were influenza, two were chicken pox and one was mumps. The cost per reported event was the highest at primary schools, followed by health facilities and then pharmacies. The annual operating cost per surveillance unit was the highest at pharmacies, followed by health facilities and finally primary schools. Both the cost per reported event and the annual operating cost per surveillance unit in Jiangxi in each of the three groups were higher than their counterparts in Hubei.ConclusionsHealth facilities and primary schools are better sources of syndromic surveillance data in the early warning of outbreaks. The annual operating costs of all the three components of the syndromic surveillance system in the ISSC Project w...

Syndromic Surveillance 2.0: Emerging Global Surveillance Strategies for Infectious Disease Epidemics

“…A systematic review tracking the efficacy of school-based surveillance systems concluded that such systems could provide one to two weeks of lead time, with high reliability, for the diagnosis of influenza outbreaks (Donaldson et al, 2021). However, we did find one study with mixed results related to school absenteeism data (Ding et al, 2015). The authors surveilled for several diseases of concern, including acute respiratory infectious diseases and gastrointestinal infectious diseases, using symptom data from health facilities, absenteeism data from primary schools (dates, numbers, ages, gender, classes, addresses, reasons for absence, and diseases or symptoms), and sales of selected medicines from pharmacies.…”

Spatial and Temporal Patterns of Typhoid and Paratyphoid Fever Outbreaks: A Worldwide Review, 1990–2018

“…This poses a major challenge to identifying outbreaks and underscores the need for improved, sustainable surveillance for enteric fever. The initial high capital cost of improving surveillance capacity may be balanced by the cost savings and health benefits wrought by early detection and accurate outbreak burden identification [54].…”

A Practitioner-Driven Research Agenda for Syndromic Surveillance

“…These costs are incurred to develop the capability to acquire and work with data from a new source; recruit, implement, and maintain each data provider; and process, monitor, and respond to the new data. 69 Similar tasks are completed when new data elements are added to existing data streams. Costs are also incurred in training staff members when new data are made available.…”