Economic studies relevant to biosurveillance can be of several types, which we summarize in Table 31.1 and discuss in this section.
The question often dictates the appropriate method. For example, do we want to know the magnitude of a problem to help decide the course of action? Are we unsure about how much money to invest in a given strategy? If a strategy has different "settings" or "calibrations," how should they be set? An analyst selects the appropriate method for a study after first defining the question. In many cases, one analytic method will not be enough, and only a progression of different methods will answer a question.
A cost-of-illness study can quantify the magnitude of a problem. It can quantify a disease's total monetary effect, including all the resulting medical costs and, if necessary, loss of productivity. A well-performed cost-of-illness study will estimate not only the total cost but also different categories of cost, such as the amount spent on medications, hospitalizations, emergency care, and days off from work, allowing one to target the areas of greatest economic burden. Often, the first step in tackling a new and unfamiliar problem is a cost-of-illness study to "map out" the problem.
After quantifying the magnitude of a problem (sometimes referred to as profiling the problem), a cost-of-intervention or cost-of-treatment analysis can estimate the cost of possible solutions. These studies calculate all the monetary costs associated with executing a solution. Such studies should include and clearly identify every important fixed and variable cost. Running multiple scenarios may show how variable costs change with different situations. Such studies can help decision makers allocate an appropriate level of funds and identify particularly costly aspects of the solution that may be targets of cost reduction.
After one profiles the possible solutions, a cost-minimization analysis (CMA), cost-benefit analysis (CBA), cost-effective analysis (CEA) or cost-utility analysis (CUA) can help choose among multiple alternative solutions. The type of problem guides the choice of analysis.
If all alternatives yield identical rewards, a CMA, which focuses only on costs, can help choose the least costly possibility. For example, if medication A and medication B have the same success rate in treating a disease, a CMA might find that medication A should be used because it costs $200 less. This type of analysis seems to apply to only a small number of not-too-difficult decisions in biosurveillance, such as which of two identical surveillance systems to purchase. We note that formally asking and conducting such a study will have the benefit of requiring clarity about whether two systems are equally effective.
3.4. Cost-Benefit Analysis
A CBA is suitable when the potential benefits are different but easily translate to monetary terms (e.g., dollars, yen, pounds).
table 31.1 Types of Economic Studies Relevant To Biosurveillance
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