A Methodological Framework for Economic Evaluation of Operational Response to Vector-Borne Diseases Based on Early Warning Systems

Despite significant advances in improving the predictive models for vector-borne diseases, only a few countries have integrated an early warning system (EWS) with predictive and response capabilities into their disease sur-veillance systems. The limited understanding of forecast performance and uncertainties by decision-makers is one of the primary factors that precludes its operationalization in preparedness and response planning. Further, predictive models exhibit a decrease in forecast skill with longer lead times, a trade-off between forecast accuracy and timeliness and effectiveness of action. This study presents a methodological framework to evaluate the economic value of EWS-triggered responses from the health system perspective. Assuming an operational EWS in place, the framework makes explicit the trade-offs between forecast accuracy, timeliness of action, effectiveness of response, and costs, and uses the net benefit analysis, which measures the benefits of taking action minus the associated costs. Uncertainty in disease forecasts and other parameters is accounted for through probabilistic sensitivity analysis. The output is the probability distribution of the net benefit estimates at given forecast lead times. A non-negative net benefit and the probability of yielding such are considered a general signal that the EWS-triggered response at a given lead time is economically via-ble. In summary, the proposed framework translates uncertainties associated with disease forecasts and other para-meters into decision uncertainty by quantifying the economic risk associated with operational response to vector-borne disease events of potential importance predicted by an EWS. The goal is to facilitate a more informed and transparent public health decision-making under uncertainty.