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Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries

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 determi...

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Autores principales: Hagedorn, Brittany, Zhou, Nicolette A., Fagnant-Sperati, Christine S., Shirai, Jeffry H., Gauld, Jillian, Wang, Yuke, Boyle, David S., Meschke, John Scott
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021573/
https://www.ncbi.nlm.nih.gov/pubmed/36962955
http://dx.doi.org/10.1371/journal.pgph.0001074
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author Hagedorn, Brittany
Zhou, Nicolette A.
Fagnant-Sperati, Christine S.
Shirai, Jeffry H.
Gauld, Jillian
Wang, Yuke
Boyle, David S.
Meschke, John Scott
author_facet Hagedorn, Brittany
Zhou, Nicolette A.
Fagnant-Sperati, Christine S.
Shirai, Jeffry H.
Gauld, Jillian
Wang, Yuke
Boyle, David S.
Meschke, John Scott
author_sort Hagedorn, Brittany
collection PubMed
description 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.
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spelling pubmed-100215732023-03-17 Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries Hagedorn, Brittany Zhou, Nicolette A. Fagnant-Sperati, Christine S. Shirai, Jeffry H. Gauld, Jillian Wang, Yuke Boyle, David S. Meschke, John Scott PLOS Glob Public Health Research Article 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. Public Library of Science 2023-01-26 /pmc/articles/PMC10021573/ /pubmed/36962955 http://dx.doi.org/10.1371/journal.pgph.0001074 Text en © 2023 Hagedorn et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hagedorn, Brittany
Zhou, Nicolette A.
Fagnant-Sperati, Christine S.
Shirai, Jeffry H.
Gauld, Jillian
Wang, Yuke
Boyle, David S.
Meschke, John Scott
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
title_full Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries
title_fullStr Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries
title_full_unstemmed Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries
title_short Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries
title_sort estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021573/
https://www.ncbi.nlm.nih.gov/pubmed/36962955
http://dx.doi.org/10.1371/journal.pgph.0001074
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