Stakeholder Engagement in the Economic Evaluation of Site-Specific Wastewater-Based Surveillance for Preventing COVID-19 Outbreaks in Long-Term Care Facilities
Author(s)
Jiabi Wen, MSc, Lisa A Wozniak, MA, Bonita E Lee, PhD, Michael Y. Li, PhD, Xiaoli Pang, PhD, Arto Ohinmaa, PhD.
University of Alberta, Edmonton, AB, Canada.
University of Alberta, Edmonton, AB, Canada.
OBJECTIVES: Wastewater-based surveillance (WBS) gained prominence as a public health surveillance approach during the COVID-19 pandemic and continues to expand its role after the pandemic. Conducting an economic evaluation of site-specific WBS for preventing COVID-19 outbreaks in long-term care facilities (LTCFs) can guide its integration into future disease control strategies and enhance decision-making. This study described stakeholders’ opinions on the application of WBS and their feedback regarding the design of an economic evaluation plan.
METHODS: We conducted two online structured interview phases via Zoom between 2023 and 2024 with nine stakeholders, including public health officials and LTCF senior administrators from different levels of health governance and provision in Alberta, Canada. The first phase explored stakeholders’ perceptions of WBS and its potential uses. The second phase confirmed key elements of economic evaluation. Interviews were analyzed using framework analysis.
RESULTS: Stakeholders had mixed opinions on applications of WBS, suggesting potential data-driven actions such as symptom screening, and prevalence testing but raised concerns about limited evidence validating these responses. Stakeholders recommended adopting a healthcare payer’s perspective, identified key cost elements, excluding long-COVID costs, and agreed on effectiveness measures to be number of cases, hospitalizations, and deaths. They agreed on two of the three model assumptions and provided further suggestions to the rest. They acknowledged the health system's willingness to pay more for effective WBS, and such willingness is influenced by the acceptance and value of WBS, non-health impacts, and disease severity.
CONCLUSIONS: Stakeholder engagement enhanced the relevance and robustness of the economic evaluation by addressing practical considerations and context-specific challenges. This study emphasized the value of integrating stakeholder insights into economic evaluations to inform public health decision-making processes.
METHODS: We conducted two online structured interview phases via Zoom between 2023 and 2024 with nine stakeholders, including public health officials and LTCF senior administrators from different levels of health governance and provision in Alberta, Canada. The first phase explored stakeholders’ perceptions of WBS and its potential uses. The second phase confirmed key elements of economic evaluation. Interviews were analyzed using framework analysis.
RESULTS: Stakeholders had mixed opinions on applications of WBS, suggesting potential data-driven actions such as symptom screening, and prevalence testing but raised concerns about limited evidence validating these responses. Stakeholders recommended adopting a healthcare payer’s perspective, identified key cost elements, excluding long-COVID costs, and agreed on effectiveness measures to be number of cases, hospitalizations, and deaths. They agreed on two of the three model assumptions and provided further suggestions to the rest. They acknowledged the health system's willingness to pay more for effective WBS, and such willingness is influenced by the acceptance and value of WBS, non-health impacts, and disease severity.
CONCLUSIONS: Stakeholder engagement enhanced the relevance and robustness of the economic evaluation by addressing practical considerations and context-specific challenges. This study emphasized the value of integrating stakeholder insights into economic evaluations to inform public health decision-making processes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE671
Topic
Economic Evaluation, Study Approaches
Disease
Geriatrics, Infectious Disease (non-vaccine)