title: Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica.
abstract: BACKGROUND
  Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization.
  
  
  OBJECTIVE
  We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica.
  
  
  METHODS
  We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated.
  
  
  RESULTS
  During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%.
  
  
  CONCLUSIONS
  Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries.
authors.affiliation: Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil. ctoscano@terra.com.br
authors.forename: C M
authors.initials: CM
authors.lastname: Toscano
authors.forename: M
authors.initials: M
authors.lastname: Vijayaraghavan
authors.forename: H M
authors.initials: HM
authors.lastname: Salazar-Bolaños
authors.forename: H M
authors.initials: HM
authors.lastname: Bolaños-Acuña
authors.forename: A I
authors.initials: AI
authors.lastname: Ruiz-González
authors.forename: T
authors.initials: T
authors.lastname: Barrantes-Solis
authors.forename: I
authors.initials: I
authors.lastname: Fernández-Vargas
authors.forename: M S
authors.initials: MS
authors.lastname: Panero
authors.forename: L H
authors.initials: LH
authors.lastname: de Oliveira
authors.forename: T B
authors.initials: TB
authors.lastname: Hyde
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003364:Costa Rica; D003365:Costs and Cost Analysis; D003625:Data Collection / Q000191:economics*; D062665:Epidemiological Monitoring; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D010175:Pan American Health Organization; D010865:Pilot Projects; D011635:Public Health Administration / Q000191:economics*; D062486:Public Health Surveillance / Q000379:methods*; D012040:Regional Health Planning / Q000191:economics; D014481:United States; D014612:Vaccines; D014944:World Health Organization
chemical_list: D014612:Vaccines