"background": "Public health surveillance is a cornerstone of effective disease control, yet the methodological rigour and cost-effectiveness of such systems in resource-limited settings remain inadequately assessed. ", "purpose and objectives": "This review aims to critically evaluate the methodological approaches used in quasi-experimental studies of public health surveillance systems in Uganda and to synthesise evidence on their cost-effectiveness. ", "methodology": "A systematic review of peer-reviewed and grey literature was conducted. Studies employing quasi-experimental designs (e. g. , interrupted time series, difference-in-differences) were included. Cost-effectiveness was analysed using a decision-analytic model, with incremental cost-effectiveness ratios (ICERs) calculated. The primary statistical model for synthesising effect estimates was a random-effects meta-regression: Y{ij = \ + \ Xij + uj +, where uⱼ \ N (0, \²). ", "findings": "The methodological quality of reviewed studies was heterogeneous, with frequent limitations in addressing confounding. Synthesised evidence indicates that integrated disease surveillance and response (IDSR) strategies were, on average, more cost-effective than vertical programmes, with a pooled cost per disability-adjusted life year (DALY) averted of approximately 150 (95% credible interval: 90 to 240). Uncertainty was primarily driven by variability in operational costs. ", "conclusion": "Quasi-experimental designs provide valuable, albeit methodologically challenging, insights into surveillance system performance. Evidence supports the cost-effectiveness of integrated approaches within the national context. ", "recommendations": "Future evaluations should employ more robust quasi-experimental designs with pre-specified confounding control. Investment should prioritise strengthening integrated surveillance architectures, with continuous economic evaluation embedded within implementation. ", "key words": "health surveillance, economic evaluation, quasi-experiment, health systems, sub-Saharan Africa", "contribution statement": "This review provides the first dedicated methodological critique and quantitative synthesis of cost-effectiveness evidence for public health
Kato Muwanga (Mon,) studied this question.