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
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.