THE COSTS AND EFFECTIVENESS OF SURVEILLANCE OF COMMUNICABLE DISEASE -A CASE-STUDY OF HIV AND AIDS IN ENGLAND AND WALES

Citation
S. Morris et al., THE COSTS AND EFFECTIVENESS OF SURVEILLANCE OF COMMUNICABLE DISEASE -A CASE-STUDY OF HIV AND AIDS IN ENGLAND AND WALES, Journal of public health medicine, 18(4), 1996, pp. 415-422
Citations number
30
Categorie Soggetti
Public, Environmental & Occupation Heath","Public, Environmental & Occupation Heath
ISSN journal
09574832
Volume
18
Issue
4
Year of publication
1996
Pages
415 - 422
Database
ISI
SICI code
0957-4832(1996)18:4<415:TCAEOS>2.0.ZU;2-7
Abstract
Background In England and Wales, surveillance of communicable disease is carried out and co-ordinated by the Public Health Laboratory Servic e (PHLS). The surveillance of HIV infection and AIDS is undertaken by the PHLS AIDS Centre at the Communicable Disease Surveillance Centre ( CDSC). Epidemiological data derived from surveillance are not, however , a free good: they are a resource with an associated opportunity cost and should therefore be open to economic appraisal alongside other us es of health care resources such as medical interventions. This paper assembles information on the current surveillance of HIV and AIDS in E ngland and Wales, and explores methods for performing an economic eval uation of such activities. Methods An examination of the cost and effe ctiveness of the PHLS AIDS Centre's epidemiological surveillance mecha nisms for HIV and AIDS in England and Wales was undertaken. The total costs of each component of surveillance of HIV and AIDS in England and Wales were calculated. Two categories of cost were estimated: periphe ral costs incurred by reporters in reporting AIDS cases or HIV infecti ons or by laboratories in collecting samples; and central casts incurr ed by the PHLS AIDS Centre in processing and analysing incoming data. Using these cast data and information from a cost-effectiveness regist er, the additional health gains that would have to be obtained from su rveillance to make the programme broadly cost-effective in comparison with other accepted uses of health service resources were then estimat ed. Results In the financial year 1993-1994 the total costs of surveil lance were estimated to be pound 1.4 million. To avoid being considere d relatively cost-ineffective at least 3.5 infections per annum need t o be averted. To be considered favourably cost-effective, approximatel y 9.5 infections per annum need to be averted. Conclusions In 1993-199 4, expenditure on surveillance of HIV and AIDS accounted for less than 1 per cent of the total allocation of resources to the National Healt h Service for all HIV and AIDS activities. Given these cost estimates, the number of infections which surveillance would have to contribute towards preventing in order to be considered cost-effective is low.