Economic evaluation of wastewater surveillance in Ontario, Canada, using COVID-19 as a case study.

Authors

Yeva Sahakyan, David Champredon, Prakathesh Rabeenthira, Alex Rodriguez Barizonte, Manon Fleury, Beate Sander

Published in

Canada communicable disease report = Releve des maladies transmissibles au Canada. Volume 52. Issue 6. Pages 246-255. Epub Jun 30, 2026.

Abstract

The COVID-19 pandemic has stimulated the use of wastewater surveillance (WWS) in Canada.
To inform continued investment, the study assessed the cost-utility of WWS, alongside conventional surveillance, compared to conventional surveillance alone, using COVID-19 in Ontario as an example.
This model-based cost-utility analysis measured WWS effectiveness by increased lead time of 1-10 days for public health response using the Ontario health system perspective. The model integrated SARS-CoV-2 transmission dynamics, SARS-CoV-2 RNA concentration in the sewage system, and disease progression. The analysis considered year-round surveillance with an outbreak occurring once in a decade, assuming WWS benefits accrue only in the outbreak year. At the individual-level, a lifetime time horizon was used and future health outcomes (quality-adjusted life years [QALYs]) and cost were discounted at 1.5%. The model was informed by population-based administrative data and was calibrated to real-world Ontario surveillance data.
For Omicron/BA.1-like outbreaks, a WWS program with a $15 million CAD/year budget maintained over 10 years would be cost-effective at a $50,000 CAD/QALY threshold if it detects an outbreak three or more days earlier, and cost-saving if it detects an outbreak 10 or more days earlier than conventional surveillance. For a less severe outbreak with lower transmission rates, e.g., XBB-like, the WWS program would be cost-effective if at least six outbreaks occur in a decade.
The study findings suggest that long-term investments in WWS are likely cost-effective for low-frequency but high-impact outbreaks. Maintaining WWS infrastructure will enhance Canada's emergency preparedness for emerging and re-emerging pathogens.

PMID:
42602915
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.