The Cost-Effectiveness of Using Site-Specific Wastewater-Based Surveillance to Monitor COVID-19 in Long-Term Care Facilities
Author(s)
Jiabi Wen, MSc1, Bonita E Lee, PhD1, Judy Y. Qiu, PhD1, Michael Y. Li, PhD1, Eleanor Risling, MD2, Lorie A. Little, MD2, Xiaoli Pang, PhD1, Arto Ohinmaa, PhD1.
1University of Alberta, Edmonton, AB, Canada, 2Alberta Health Services, Edmonton, AB, Canada.
1University of Alberta, Edmonton, AB, Canada, 2Alberta Health Services, Edmonton, AB, Canada.
OBJECTIVES: Site-specific wastewater-based surveillance (WBS) has demonstrated its ability in the early detection of COVID-19 cases in long-term care facilities (LTCFs) and other building-specific COVID-19 surveillance contexts. However, its real-world cost-effectiveness is unknown. This study evaluated the cost-effectiveness of site-specific WBS implemented in Edmonton, Canada, from March 2020 to February 2023, from a public payer’s perspective.
METHODS: We developed a Suspected-Infected-Case-Recovered model that integrated real-world wastewater surveillance and COVID-19 outbreak data to estimate the costs and effectiveness of using WBS versus the standard of care to monitor and control COVID-19 in LTCFs. Stakeholders from various levels of Alberta’s health governance contributed to designing wastewater-informed outbreak responses and the evaluation plan. Epidemiological data and cost data were obtained from Alberta Health Services. The incremental cost-effectiveness ratio (ICER) of WBS compared to the standard of care was calculated using probabilistic analysis across three pandemic phases: Phase 1 (March 2020 - February 2021), Phase 2 (March - November 2021), and Phase 3 (December 2021 - February 2023).
RESULTS: Nine LTCFs in Edmonton participated in the WBS program. WBS was most cost-effective during Phase 1, yielding an expected gain of 6.8 quality-adjusted life years (QALYs) and an additional healthcare cost of $13,941 compared to the standard of care, resulting in an expected ICER of $2,065/QALY. At a $50,000/QALY willingness-to-pay threshold, the probability of WBS being cost-effective and cost-saving was 96.3% and 39.6%, respectively. When all three phases were combined, WBS had an overall ICER of $47,263/QALY, with a 39.9% probability of being cost-effective at the same threshold.
CONCLUSIONS: Site-specific WBS is likely a cost-effective tool for mitigating COVID-19 impacts in LTCFs, particularly during the early stages of the pandemic, to protect vulnerable older populations. The findings support its continued use to complement traditional clinical surveillance and guide more strategic, timely responses to ongoing and emerging infectious disease challenges.
METHODS: We developed a Suspected-Infected-Case-Recovered model that integrated real-world wastewater surveillance and COVID-19 outbreak data to estimate the costs and effectiveness of using WBS versus the standard of care to monitor and control COVID-19 in LTCFs. Stakeholders from various levels of Alberta’s health governance contributed to designing wastewater-informed outbreak responses and the evaluation plan. Epidemiological data and cost data were obtained from Alberta Health Services. The incremental cost-effectiveness ratio (ICER) of WBS compared to the standard of care was calculated using probabilistic analysis across three pandemic phases: Phase 1 (March 2020 - February 2021), Phase 2 (March - November 2021), and Phase 3 (December 2021 - February 2023).
RESULTS: Nine LTCFs in Edmonton participated in the WBS program. WBS was most cost-effective during Phase 1, yielding an expected gain of 6.8 quality-adjusted life years (QALYs) and an additional healthcare cost of $13,941 compared to the standard of care, resulting in an expected ICER of $2,065/QALY. At a $50,000/QALY willingness-to-pay threshold, the probability of WBS being cost-effective and cost-saving was 96.3% and 39.6%, respectively. When all three phases were combined, WBS had an overall ICER of $47,263/QALY, with a 39.9% probability of being cost-effective at the same threshold.
CONCLUSIONS: Site-specific WBS is likely a cost-effective tool for mitigating COVID-19 impacts in LTCFs, particularly during the early stages of the pandemic, to protect vulnerable older populations. The findings support its continued use to complement traditional clinical surveillance and guide more strategic, timely responses to ongoing and emerging infectious disease challenges.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE695
Topic
Economic Evaluation, Methodological & Statistical Research
Disease
Geriatrics, Infectious Disease (non-vaccine)