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cost, syndromic surveillance, systems analysis



  1. Kirkwood, Amy MS
  2. Guenther, Eric MPH
  3. Fleischauer, Aaron T. PhD, MPH
  4. Gunn, Julia MPH, RN
  5. Hutwagner, Lori MS
  6. Barry, M. Anita MD, MPH


Objective: Enhancing public health surveillance to include electronic syndromic surveillance systems has received increased attention in recent years. Although cost continually serves as a critical factor in public health decision making, few studies have evaluated direct costs associated with syndromic surveillance systems. In this study, we calculated the direct costs associated with developing and implementing a syndromic surveillance system in Boston, Massachusetts, from the perspective of local, state, and federal governments.


Methods: Between December 2003 and July 2005, the Boston Public Health Commission (BPHC), in collaboration with the Centers for Disease Control and Prevention (CDC), and the Massachusetts Department of Public Health developed a syndromic surveillance system in which limited demographic and chief complaint data are collected from all Boston acute care emergency departments every 24 hours. Costs were divided into three categories: development, operation, and upgrade. Within these categories, all fixed and variable costs incurred by both BPHC and CDC were assessed, including those associated with development of syndromic surveillance-related city regulations and system enhancements.


Results: The total estimated direct cost of system development and implementation during the study period was $422,899 ($396,716 invested by BPHC and $26,183 invested by CDC). Syndromic system enhancements to improve situational awareness accounted for $74,389.


Conclusion: Development, implementation, and operation of a syndromic surveillance system accounted for a relatively small proportion of surveillance costs in a large urban health department. Funding made available for a future cost-benefit analysis, and an assessment of local epidemiologic capacity will help to guide decisions for local health departments. Although not a replacement for traditional surveillance, syndromic surveillance in Boston is an important and relatively inexpensive component of a comprehensive local public health surveillance system.