Cost-Effectiveness of a Targeted Disinfection Program in Household Kitchens To Prevent Foodborne Illnesses in the United States, Canada, and the United Kingdom

Foodborne illnesses impose a substantial economic and quality-of-life burden on society by way of acute morbidity and chronic sequelae. We developed an economic model to evaluate the potential cost-effectiveness of a disinfection program that targets high-risk food preparation activities in household kitchens. For the United States, Canada, and the United Kingdom, we used published literature and expert opinion to estimate the cost of the program (excluding the educational component); the number of cases of Salmonella, Campylobacter, and Escherichia coli O157:H7 infections prevented; and the economic and quality-of-life outcomes. In our primary analysis, the model estimated that approximately 80,000 infections could be prevented annually in U.S. households, resulting in $138 million in direct medical cost savings (e.g., physician office visits and hospitalizations avoided), 15,845 quality-adjusted life-years (QALYs) gained, $788 million in program costs, and a favorable cost-effectiveness ratio of $41,021/QALY gained. Results were similar for households in Canada and the United Kingdom (Can $21,950/QALY gained and £86,341/QALY gained, respectively). When we evaluated implementing the program only in U.S. households with high-risk members (those less than 5 years of age, greater than 65 years of age, or immunocompromised), the cost-effectiveness ratio was more favorable ($10,163/QALY gained). Results were similar for high-risk households in Canada and the United Kingdom (Can$1,915/QALY gained and £28,158/QALY gained, respectively). Implementing a targeted disinfection program in household kitchens in the United States, Canada, and the United Kingdom appears to be a cost-effective strategy, falling within the range generally considered to warrant adoption and diffusion (<$100,000/QALY gained).