Volume 6, Number 3—June 2000
Costs and Benefits of a Subtype-Specific Surveillance System for Identifying Escherichia coli O157:H7 Outbreaks
|Discounted average cost of an E. coli O157:H7 infection||$7,788||$15,927||$5,847|
|Discounted costs of installing and operating the system||$182,042||$192,000||$176,018|
|Baseline (best estimate)|
|Cases that need to be averted every year for 5 yearsb||5.0||2.4||6.6|
|Cases that need to be averted in the first year alonec||14.2||7.2||18.5|
|One-way sensitivity analysis|
|Increasing labor and equipment costs from $20,000 to $50,000|
|Cases that need to be averted every year for 5 yearsb||6.4||3.1||8.6|
|Cases that need to be averted in the first year alonec||20.9||10.6||27.2|
|Decreasing the costs of an infection from $7,788 to $3,894|
|Cases that need to be averted every year for 5 yearsb||9.9||4.8||13.2|
|Cases that need to be averted in the first year alonec||28.4||14.5||36.9|
|Increasing the probability of death from 0.4% to 2.3%|
|Cases that need to be averted every year for 5 yearsb||1.5||0.5||2.6|
|Cases that need to be averted in the first year alonec||4.3||1.5||7.3|
aThe most frequently assumed discount rate is 5%. However, 3% is the recommended rate. No discounting is suggested for testing the sensitivity of the results (10).
bThreshold number of cases averted every year for 5 years above which the system is cost-beneficial.
cThreshold number of cases averted in the first year above which the system is cost-beneficial, assuming the system does not avert any cases in subsequent years and continues to incur costs.
- Griffin PM, Tauxe RV. The epidemiology of infections caused by Escherichia coli O157:H7, other enterohemorrhagic E. coli, and the associated hemolytic uremic syndrome. Epidemiol Rev. 1991;13:60–98.
- American Gastroenterological Association. Consensus statement: Escherichia coli O157:H7 infections: an emerging national health crisis, July 11-13, 1994. Gastroenterology. 1995;108:1923–34.
- Roberts T, Buzby J, Lin J, Mead P, Nunnery P, Tarr PI. Economic aspects of E. coli O157:H7: disease outcome trees, risk, uncertainty, and social cost of disease estimates. In: Prediction, detection, and management of tomorrow's epidemics. Greenwood B, De Cock K, eds. John Wiley & Sons, Chichester, UK. pp 156-72.
- Buzby JC, Roberts T, Lin JC-T, MacDonald JM. Bacterial foodborne disease: medical costs and productivity losses. Washington: U.S. Department of Agriculture, Economic Research Service. AER No. 741. August 1996.
- Centers for Disease Control and Prevention. Preliminary report: foodborne outbreak of Escherichia coli O157:H7 infections from hamburgers--western United States, 1993. MMWR Morb Mortal Wkly Rep. 1993;42:85–6.
- Bender JB, Hedberg CW, Besser JM, Boxrud DJ, MacDonald KL, Osterholm MT. Surveillance for Escherichia coli O157:H7 infections in Minnesota by molecular subtyping. N Engl J Med. 1997;337:388–94.
- Kolata G. Detective work and science reveal a new lethal bacteria. New York Times. 1998 Jan 6;147:A1, A14.
- Bell BP, Goldoft M, Griffin PM, Davis MA, Gordon DC, Tarr PI, A multiple outbreak of Escherichia coli O157:H7-associated bloody diarrhea and hemolytic uremic syndrome from hamburgers: the Washington State experience. JAMA. 1994;272:1349–53.
- Haddix AC, Teutsch SM, Shaffer PA, Dunet DO, eds. A guide to decision analysis and economic evaluation. New York: Oxford University Press; 1996.
- Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
- Landefeld JS, Seskin EP. The economic value of life: linking theory to practice. Am J Public Health. 1982;6:555–66.
- Centers for Disease Control and Prevention. Enhanced detection of sporadic Escherichia coli O157:H7 infections--New Jersey, July, 1994. MMWR Morb Mortal Wkly Rep. 1993;44:417–8.
- Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 1998. MMWR Morb Mortal Wkly Rep. 1999;47:1–93.