■COVID-19大流行强调了病原体监测系统的必要性,以加强预警和暴发监测/控制工作。社区废水样本提供了快速准确的环境监测数据来源,以补充直接患者采样。由于其全球存在和关键任务,美国军方是全球大流行准备工作的领导者。在美国空军(USAF)基地(AFB)上对COVID-19进行的临床试验是有效的,但由于损失的时间而导致的直接货币成本和间接成本昂贵。为了保持在峰值容量下运行,这些基地寻求更被动的监测方案,并在17个AFB试点废水监测(WWS),以证明可行性,安全,实用程序,和成本效益,从2021年5月到2022年1月。
我们使用基于美国空军和化学联合计划执行办公室的结果的假设,在美国军事设施的特定背景下,对公共卫生问题病原体的废水计划的成本进行建模。生物,辐射和核防御试点计划。目的是确定相对于临床拭子测试监测方案,将WWS部署到所有AFB的成本。
■WWS成本预测模型是根据主题专家的投入和美国空军在WWS试点计划期间产生的实际成本建立的。考虑了几种SARS-CoV-2循环情况,并预测了WWS和临床拭子测试的成本。进行了分析以确定盈亏平衡点以及减少拭子测试如何解锁资金以使WWS并行发生。
■我们的模型证实,与现有的替代形式的生物监测相比,WWS具有互补性和高成本效益。我们发现,与临床拭子测试监测相比,WWS的成本每年在直接成本上便宜10.5到1850万美元之间。当损失工作的间接成本被纳入时,包括与所需的临床拭子测试相关的工作损失,我们估计,在实施WWS后,超过2/3的临床拭子检测可以维持,无需额外费用.
■我们的结果支持在美国军事设施中采用WWS,作为更全面和早期预警系统的一部分,该系统将以比单独的拭子测试更具成本效益的方式在疾病暴发期间进行自适应监测。
UNASSIGNED: The COVID-19 pandemic highlighted the need for pathogen surveillance systems to augment both early warning and outbreak monitoring/control efforts. Community wastewater samples provide a rapid and accurate source of environmental surveillance data to complement direct patient sampling. Due to its global presence and critical missions, the US military is a leader in global pandemic preparedness efforts. Clinical testing for COVID-19 on US Air Force (USAF) bases (AFBs) was effective but costly with respect to direct monetary costs and indirect costs due to lost time. To remain operating at peak capacity, such bases sought a more passive surveillance option and piloted wastewater surveillance (WWS) at 17 AFBs to demonstrate feasibility, safety, utility, and cost-effectiveness from May 2021 to January 2022.
UNASSIGNED: We model the costs of a wastewater program for pathogens of public health concern within the specific context of US military installations using assumptions based on the results of the USAF and Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense pilot program. The objective was to determine the cost of deploying WWS to all AFBs relative to clinical swab testing surveillance regimes.
UNASSIGNED: A WWS cost projection model was built based on subject matter expert input and actual costs incurred during the WWS pilot program at USAF AFBs. Several SARS-CoV-2 circulation scenarios were considered, and the costs of both WWS and clinical swab testing were projected. Analysis was conducted to determine the break-even point and how a reduction in swab testing could unlock funds to enable WWS to occur in parallel.
UNASSIGNED: Our model confirmed that WWS is complementary and highly cost-effective when compared to existing alternative forms of biosurveillance. We found that the cost of WWS was between US $10.5-$18.5 million less expensive annually in direct costs as compared to clinical swab testing surveillance. When the indirect cost of lost work was incorporated, including lost work associated with required clinical swab testing, we estimated that over two-thirds of clinical swab testing could be maintained with no additional costs upon implementation of WWS.
UNASSIGNED: Our results support the adoption of WWS across US military installations as part of a more comprehensive and early warning system that will enable adaptive monitoring during disease outbreaks in a more cost-effective manner than swab testing alone.