RESUMEN
BACKGROUND: As low probability events, United States producers, value chain actors, and veterinary services (VS) have limited experience with identifying foreign animal disease (FAD), which can allow FADs to spread undetected. Point-of-care (POC) diagnostic testing may help reduce the time from detecting an initial suspect case to implementing actionable interventions compared to the current approach of only using laboratory diagnostic testing for disease diagnosis and confirmation. To evaluate the value of the reduced response time, we compare the associated costs between the two diagnostic approaches while accounting for the uncertainty surrounding the size of a FAD event. METHODS: We apply a state-contingent approach (SCA) to model the uncertainty surrounding a FAD through alternative events, where the event defines the scale of outbreak size and its duration. We apply this approach within a cost-benefit framework (CBA) to determine the economic value from the two testing investment strategies to help explain the policymaker's response (and costs) to alternative FAD events while also considering the cost impacts on the producers from each event. RESULTS: Compared to the current laboratory strategy, a POC strategy that reduces response time by 0.5-days (swine, cattle scenarios) and 1.5-days (poultry scenario) may provide cost-saving to both producers and public response efforts. The benefit-cost analysis further suggests that despite the higher fixed costs to adopt the POC strategy, the swine and cattle sectors may benefit while the benefits may not be as pronounced in the poultry sector. DISCUSSION: POC testing that can reduce the time between detection and response during a FAD event may be a sound strategy for public expenditure and provide cost-savings for producers, especially when minimal fixed costs are incurred. However, to fully determine the value of POC testing, the consequences (costs) associated with potential actions if something goes wrong, (e.g. false positive results), should be considered in future studies.
Asunto(s)
Análisis Costo-Beneficio , Pruebas en el Punto de Atención , Animales , Estados Unidos , Bovinos , Pruebas en el Punto de Atención/economía , Porcinos , Enfermedades de los Porcinos/diagnóstico , Enfermedades de los Porcinos/economía , Enfermedades Transmisibles Importadas/veterinaria , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/prevención & control , Enfermedades Transmisibles Importadas/economía , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/economía , Enfermedades de las Aves de Corral/diagnóstico , Enfermedades de las Aves de Corral/economía , Sistemas de Atención de Punto/economía , Aves de Corral , Brotes de Enfermedades/veterinaria , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/economía , Factores de TiempoRESUMEN
BACKGROUND: Measles importations and the subsequent spread from US travelers returning from abroad are responsible for most measles cases in the United States. Increasing measles-mumps-rubella (MMR) vaccination among departing US travelers could reduce the clinical impact and costs of measles in the United States. METHODS: We designed a decision tree to evaluate MMR vaccination at a pretravel health encounter (PHE), compared with no encounter. We derived input parameters from Global TravEpiNet data and literature. We quantified Riskexposure to measles while traveling and the average number of US-acquired cases and contacts due to a measles importation. In sensitivity analyses, we examined the impact of destination-specific Riskexposure, including hot spots with active measles outbreaks; the percentage of previously-unvaccinated travelers; and the percentage of travelers returning to US communities with heterogeneous MMR coverage. RESULTS: The no-encounter strategy projected 22 imported and 66 US-acquired measles cases, costing $14.8M per 10M travelers. The PHE strategy projected 15 imported and 35 US-acquired cases at $190.3M per 10M travelers. PHE was not cost effective for all international travelers (incremental cost-effectiveness ratio [ICER] $4.6M/measles case averted), but offered better value (ICER <$100 000/measles case averted) or was even cost saving for travelers to hot spots, especially if travelers were previously unvaccinated or returning to US communities with heterogeneous MMR coverage. CONCLUSIONS: PHEs that improve MMR vaccination among US international travelers could reduce measles cases, but are costly. The best value is for travelers with a high likelihood of measles exposure, especially if the travelers are previously unvaccinated or will return to US communities with heterogeneous MMR coverage.
Asunto(s)
Enfermedades Transmisibles Importadas/economía , Enfermedades Transmisibles Importadas/prevención & control , Análisis Costo-Beneficio , Vacuna contra el Sarampión-Parotiditis-Rubéola/economía , Sarampión/economía , Sarampión/prevención & control , Enfermedad Relacionada con los Viajes , Adulto , Enfermedades Transmisibles Importadas/epidemiología , Femenino , Humanos , Masculino , Sarampión/epidemiología , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Background On August 24, 2011, 31 US-bound refugees from Kuala Lumpur, Malaysia (KL) arrived in Los Angeles. One of them was diagnosed with measles post-arrival. He exposed others during a flight, and persons in the community while disembarking and seeking medical care. As a result, 9 cases of measles were identified. Methods We estimated costs of response to this outbreak and conducted a comparative cost analysis examining what might have happened had all US-bound refugees been vaccinated before leaving Malaysia. Results State-by-state costs differed and variously included vaccination, hospitalization, medical visits, and contact tracing with costs ranging from $621 to $35,115. The total of domestic and IOM Malaysia reported costs for US-bound refugees were $137,505 [range: $134,531 - $142,777 from a sensitivity analysis]. Had all US-bound refugees been vaccinated while in Malaysia, it would have cost approximately $19,646 and could have prevented 8 measles cases. Conclusion A vaccination program for US-bound refugees, supporting a complete vaccination for US-bound refugees, could improve refugees' health, reduce importations of vaccine-preventable diseases in the United States, and avert measles response activities and costs.