Benefit-cost analysis of bubonic plague surveillance and control at two campgrounds in California, USA

A benefit-cost analysis was performed at the request of the California Department of Health Services on its plague control program at 2 California campgrounds. In addition to the current control program, consisting of surveillance and control, a surveillance-only program and 2 no-program alternatives were considered. The results showed that the current control program was economically preferable, with an average annual net benefit of ca. $2000. Ranking the suboptimal alternatives showed that the no-program/open-park alternative was the next preferable, followed by the surveillance-only program, then the no-program/park-closure alternative. Sensitivity analysis showed that the current control program would remain optimal if the initial assumptions were reasonably accurate. However, the results were highly sensitive to the assumed number of human cases and frequency of epidemics. Slight overstatement of these factors might incorrectly favor the current control program over the no-program/open-park alternative. Methodology developed in this study may be applied to an evaluation of the California (or other statewide/regional) plague control programs.