Economic considerations often influence the selection, use, and even success of biosurveillance systems. Organizations, when acquiring or planning biosurveillance systems, take into account the considerable financial resources required to develop, use, and maintain such systems, as well as the feasibility and costs of recruiting and retaining capable personnel. Organizations consider the effects of false alarms, which result in the unnecessary mobilization of multiple resources. False alarms can be expensive and in the extreme case may lead to a boy-who-cried-wolf effect in which users of a system begin to ignore a system either partially or completely. Without a proper understanding of the tradeoffs between action and inaction discussed in the previous two chapters, users of a biosurveillance system may also under-react or delay response to early warning signs of an outbreak, potentially resulting in higher levels of injury, loss of life, and damage to the psychology, operations, and infrastructure of the affected region.

Economic studies can contribute to the rational selection, optimal use, and success of biosurveillance systems. An economic study is a formal scientific analysis of different choices that individuals, organizations, or societies have to make when resources are scarce. Economic studies can assist an organization in all phases of biosurveillance system operation: from acquisition to setting of alarm thresholds, to decision making in novel situations. In particular, economic studies of such decisions make explicit the choices available in each situation and the potential costs and rewards of each choice. Economic studies can provide guidance to organizations about how much and where to invest in biosurveillance and what level and type of biosurveillance to develop and maintain. They can provide guidance about whether to develop and configure a biosurveillance system that can catch subtle early warning signs but potentially generate many false alarms, or one that only looks for very suspicious warning signs but may miss insidious cases.

Although the field of economics is mature with many well-established techniques for conducting economic studies, researchers have only rarely applied these techniques to problems in biosurveillance. The economic subfield of biosurveillance is still in its infancy and is relatively uncharted territory. We expect this subfield to grow. For this reason, this chapter will review the strengths and limitations of existing economic techniques and provide examples of these techniques applied to the analysis of decision problems in biosurveillance and, in particular, the modeling of the consequences of outbreaks and bioterrorism. It will also discuss the challenges faced in applying economics in biosurveillance as well as potential future directions.

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