Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries.
| Title: | Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries. |
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| Authors: | Hagedorn B; Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, United States of America.; Zhou NA; Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America.; Fagnant-Sperati CS; Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America.; Shirai JH; Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America.; Gauld J; Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, United States of America.; Wang Y; Center of Global Safe Water, Sanitation, and Hygiene in the Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America.; Boyle DS; Diagnostics Program, PATH, Seattle, WA, United States of America.; Meschke JS; Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America. |
| Source: | PLOS global public health [PLOS Glob Public Health] 2023 Jan 26; Vol. 3 (1), pp. e0001074. Date of Electronic Publication: 2023 Jan 26 (Print Publication: 2023). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 9918283779606676 Publication Model: eCollection Cited Medium: Internet ISSN: 2767-3375 (Electronic) Linking ISSN: 27673375 NLM ISO Abbreviation: PLOS Glob Public Health Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: San Francisco, California : Public Library of Science, [2021]- |
| Abstract: | 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.; (Copyright: © 2023 Hagedorn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) |
| Competing Interests: | The authors have declared that no competing interests exist. |
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| Entry Date(s): | Date Created: 20230324 Latest Revision: 20230327 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10021573 |
| DOI: | 10.1371/journal.pgph.0001074 |
| PMID: | 36962955 |
| Database: | MEDLINE |
Journal Article