Structured Expert Judgment for Informing the Return on Investment in Surveillance : The Case of Environmental Public Health Tracking

We use the classical model of structured expert judgment to examine the return on investment (ROI) in a health surveillance network. The US Centers for Disease Control and Prevention launched the Environmental Public Health Tracking Program (Tracking Program) in 2002 to collect available data to better understand the link between health and the environment. The Tracking Program's annual budget is $25 million, but little is known about the value of its potential benefits. Past evaluations of the Tracking Program have focused on its ability to meet its own goals rather than on broader impact. This study is the first quantitative assessment of the ROI of the Tracking Program. We make novel use of structured expert judgment to establish a counterfactual allowing us to examine the program's impact. We then link the estimated impact to existing literature on the economic benefits associated with the improved indicators. We estimate that the Tracking Program may have yielded between $5.22 billion to $17.1 billion in societal benefits in 2011, with $6.24 billion estimated by the optimized combination of experts. The estimates have a wide range of uncertainty, but these amounts are significantly greater than the annual $25 million cost of the program