Issue a boil-water advisory or wait for definitive information? A decision analysis

Area of Science:

• Public Health
• Epidemiology
• Decision Science

Background:

• Boil-water advisories are critical public health interventions.
• Timely decisions are essential during potential disease outbreaks.
• Surveillance data, like increased sales of diarrhea remedies, can signal outbreaks but are not always conclusive.

Purpose of the Study:

• To model the decision-making process for issuing boil-water advisories.
• To compare the outcomes of immediate advisories versus a test-and-wait strategy.
• To determine the threshold cost at which immediate advisories become optimal.

Main Methods:

• Decision analysis was employed to model the choice between immediate action and delayed testing.
• The model evaluated the costs and benefits associated with each decision strategy.
• Key variables included the cost of issuing an advisory and the time to definitive test results.

Main Results:

• The base-case analysis indicated that a test-and-wait approach is the optimal decision.
• An immediate boil-water advisory becomes the preferred strategy if the daily cost per person exceeds 13.92 cents.
• This highlights a critical cost-benefit threshold for public health decision-making.

Conclusions:

• Decisions regarding public health interventions can be effectively modeled using surveillance data, even when data is suggestive rather than conclusive.
• The study provides a framework for optimizing responses to potential disease outbreaks.
• Economic factors play a significant role in determining the most effective public health strategy.