In another example of the value of investing in public health, a recent study finds that PulseNet, a national foodborne illness outbreak network, prevents about 276,000 illnesses every year, which translates into savings of $507 million in medical costs and lost productivity. That’s a pretty big return on investment for a system that costs just $7.3 million annually to operate.
Created 20 years ago and coordinated by the Centers for Disease Control and Prevention, PulseNet includes 83 state and federal laboratories and identifies about 1,750 disease clusters every year. It works by linking together public health laboratories so they can rapidly share information on foodborne illnesses in real time, compare the DNA profiles of foodborne pathogens, tie together cases that may be occurring across multiple states, and quickly identify a disease outbreak. This kind of information is essential to pinpointing the source of contaminated food, promptly alerting consumers and manufacturers, and eventually stopping the outbreak’s spread. PulseNet perfectly illustrates public health in action and the value of investing in population-based prevention.
But until this new study, which was recently published online in the American Journal of Preventive Medicine, public health officials didn’t have a value they could assign to PulseNet. (Unfortunately, trying to put a value on efforts that prevent disease and injury from happening in the first place is a common problem in public health. At the same time, calculating such value is incredibly important for a field that routinely struggles with budget shortfalls and funding cuts. But, back to the study.) Using data collected by PulseNet between 1994 and 2009, researchers found that the system prevented 266,522 illnesses from salmonella, 9,489 illnesses from E. coli, and 56 illnesses due to listeria every year. And that, researchers said, is a conservative estimate that accounts for under-reporting and underdiagnosis.
Every year in the U.S., 48 million foodborne illnesses occur, resulting in 128,000 hospitalizations and 3,000 deaths. Study authors Robert Scharff, John Besser, Donald Sharp, Timothy Jones, Peter Gerner-Smidt and Craig Hedberg write:
This evaluation of PulseNet demonstrated significant economic and public health benefits from the system. These benefits are driven by improvements in outbreak detection, which provide industry and government with valuable information, while exposing food producers to increased threat from litigation and reputation losses. This ultimately leads to adjustments in processes that reduce foodborne illness. The measurable costs of the program, in contrast, are very modest.
The study found that the quicker identification of disease outbreaks, which leads to quicker recalls, resulted in 16,994 fewer cases of salmonella and 2,819 fewer cases of E. coli each year. Researchers calculated that the prevention of those disease cases resulted in a savings of $37 million. Regarding the return on investment, they reported that disease prevention attributable to better industry practices has resulted in $14 million-$647 million in median reduced costs, which translates into a return of $3-$90 for every $1 invested by public health agencies. The impact of better food recalls yielded $29 million in savings, with a return of up to $5 for every $1 invested by public health agencies. Overall, for every $1 spent on PulseNet, $70 is saved.
“PulseNet has provided an incredible return on investment with hundreds of thousands of people able to stay healthy as a result of this early warning system,” said CDC Director Tom Frieden in an agency news release. “Advanced molecular detection technology, such as whole genome sequencing, is enhancing CDC PulseNet’s ability to save lives right now — and promises to save more American lives in the future.”
PulseNet was launched in response to the 1993 E. coli outbreak eventually tied to the fast food chain Jack in the Box and that sickened more than 700 people and killed four. At the time, according to CDC, it took public health workers 39 days to establish that the cases were linked and to identify an outbreak. And it took more than a month after the first person fell ill to identify the contaminated food source. In comparison, in 2002 after PulseNet was in place, it took public health investigators 18 days to detect an E. coli outbreak in Colorado — that outbreak resulted in 44 illnesses and no deaths.
Read the full study on PulseNet’s health and economic benefits at the American Journal of Preventive Medicine.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.