Evaluating the Cost-Effectiveness of Wastewater-Based Disease Surveillance
Author(s)
Karina Wallrafen-Sam, MSPH1, Nicole Zacharias, PhD2, Raquel Rubio Acero, PhD3, Andreas Walker, PhD4, Marcus Lukas, PhD5, Beate Schneider, PhD5, Sophia Beyer, PhD6, Timo Greiner, PhD6, Jakob Schumacher, PhD6, Jan Hasenauer, PhD1;
1University of Bonn, Bonn, Germany, 2University Hospital Bonn, Bonn, Germany, 3LMU University Hospital, Munich, Germany, 4University Hospital Düsseldorf, Düsseldorf, Germany, 5German Environment Agency, Berlin, Germany, 6Robert Koch Institute, Berlin, Germany
1University of Bonn, Bonn, Germany, 2University Hospital Bonn, Bonn, Germany, 3LMU University Hospital, Munich, Germany, 4University Hospital Düsseldorf, Düsseldorf, Germany, 5German Environment Agency, Berlin, Germany, 6Robert Koch Institute, Berlin, Germany
Presentation Documents
OBJECTIVES: The recent COVID-19 pandemic has led to increased interest in wastewater-based surveillance systems, which - unlike traditional case-based surveillance - are not subject to underreporting and can benefit from economies of scale when multiple diseases or regions are under surveillance at once. The costs of wastewater surveillance may vary across locations and its effectiveness is context-dependent, so a comprehensive overview of its cost-effectiveness is lacking. As such, this research explores the comparative cost-effectiveness of wastewater- versus individual testing-based surveillance systems in different scenarios.
METHODS: We collected and analysed data on the running costs of wastewater surveillance from five laboratories across Germany. Via a comprehensive simulation study of emerging infectious disease outbreaks in a synthetic small city, we compared the cost per unit decrease in distance between the true and estimated case curve for wastewater-based surveillance versus random individual antigen testing. Additionally, we used an agent-based model of a 300-person nursing home to compare the cost per case averted for different testing-and-isolation strategies.
RESULTS: We confirm that the costs of wastewater surveillance vary significantly across laboratories, even within a single country, based on factors such as the choice of PCR technology and sample transportation approach, but find that certain recommendations hold across settings: for example, investments in automatic extraction equipment are quickly offset by efficiency gains. In the small city context, we find that a wastewater-based surveillance approach can achieve similar accuracy to an individual testing-based approach for about one-tenth of the cost. However, in the high-risk nursing home context, we find that neither approach consistently outperforms the other.
CONCLUSIONS: Wastewater-based surveillance has clear cost-related advantages over active individual testing-based surveillance in larger and more heterogeneous populations. Our modelling study can help guide public health decision-makers in choosing the most cost-effective surveillance approach for a particular context.
METHODS: We collected and analysed data on the running costs of wastewater surveillance from five laboratories across Germany. Via a comprehensive simulation study of emerging infectious disease outbreaks in a synthetic small city, we compared the cost per unit decrease in distance between the true and estimated case curve for wastewater-based surveillance versus random individual antigen testing. Additionally, we used an agent-based model of a 300-person nursing home to compare the cost per case averted for different testing-and-isolation strategies.
RESULTS: We confirm that the costs of wastewater surveillance vary significantly across laboratories, even within a single country, based on factors such as the choice of PCR technology and sample transportation approach, but find that certain recommendations hold across settings: for example, investments in automatic extraction equipment are quickly offset by efficiency gains. In the small city context, we find that a wastewater-based surveillance approach can achieve similar accuracy to an individual testing-based approach for about one-tenth of the cost. However, in the high-risk nursing home context, we find that neither approach consistently outperforms the other.
CONCLUSIONS: Wastewater-based surveillance has clear cost-related advantages over active individual testing-based surveillance in larger and more heterogeneous populations. Our modelling study can help guide public health decision-makers in choosing the most cost-effective surveillance approach for a particular context.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH58
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)