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. 2023 Aug;29(8):1608–1617. doi: 10.3201/eid2908.221775

Table 5. Base-case analysis using a deterministic model and a probabilistic model in an economic evaluation of wastewater surveillance combined with clinical COVID-19 screening tests, Japan*.

Incidence† Option 1
Option 2
Relative value of option 2
Cost Benefit ROI 1‡ Cost Benefit ROI 2‡ Inc. cost§ Inc. benefit¶ Rel. ROI#
10
DA $67.04 $1.39 0.021 $53.60 $1.14 0.021 –$13.44 –$0.25 54
Mean PA 
 (95% PCI)
$70.03 ($49.85–$90.25)
$1.43 ($0.42–$2.85)
0.021 (0.006–0.043)

$50.68 ($25.27–$90.23)
$0.97 ($0.19–$2.04)
0.021 (0.004–0.051)

–$19.35 
(–$54.48 to $24.31)
–$0.46 
(–$1.20 to $0.08)
45 
(−194 to 387)
100
DA $67.05 $14.09 0.21 $53.61 $11.94 0.22 –$13.43 –$2.15 6.25
Mean PA 
 (95% PCI)
$68.54 ($48.77–$88.86)
$14.75 ($5.11–$28.35)
0.22 
(0.07–0.45)

$50.86 ($24.95–$92.14)
$10.37 ($3.03–$20.71)
0.23
(0.05–0.60)

–$17.68 
(–$52.33 to $23.34)
–$4.38 
(–$11.35 to $1.31)
5.74 
(−24 to 37)
1,000
DA $67.12 $141.11 2.10 $53.75 $119.94 2.23 –$13.37 –$21.16 0.63
Mean PA 
 (95% PCI) $69.50 ($48.76–$89.54) $147.29 ($52.37– $279.00) 2.17 
(0.73–4.57) $50.61 ($24.56–$89.89) $104.58 ($30.91–$215.00) 2.29 
(0.55–5.59) –$18.89 
(–$52.28 to $23.15) –$42.71 
(–$110 to $8.65) 0.34 (−2.14 to 3.71)

*A probabilistic model to compare clinical tests only (option 1) to wastewater surveillance combined with clinical tests (option 2). If one option is cost-saving compared with its comparator, the option’s ROI is estimated to exceed 1. The comparator of options 1 and 2 is do-nothing. DA, deterministic model analysis; inc., incremental; PA, probabilistic model analysis with Monte Carlo simulations; PCI, probabilistic confidence interval; rel., relative; ROI, return on investment. †Disease incidence per day per 1 million residents in the area. ‡ROI is benefit divided by cost for each option. §Incremental cost is the cost of option 2 minus cost of option 1. A negative value of incremental cost indicates that option 2 has a lower cost or is cost-saving, compared with option 1. This could be interpreted as option 2’s relative benefit. ¶Incremental benefit is the benefit of option 2 minus benefit of option 1. A negative value of incremental benefit indicates that option 2 has a lower benefit compared with option 1, which could be interpreted as option 2’s relative cost. #Relative ROI is incremental cost divided by incremental benefit.