228 P. Livingstone and N. Hancox
definition, stakeholders control the strategic
direction of the TB programme and its required
revenue. A critical step in developing an effective
TB programme is thus to identify and involve
stakeholder leaders to ensure they understand
the benefits for their members and the wider
community.
15.2.7 PlanningPlanning towards effective delivery of strategic
objectives requires science-based tools, knowl-
edge and understanding of TB epidemiology
(including diagnostics, herd history analysis,
cattle management factors and modelling
capacity) supported by robust policy develop-
ment and economic analysis. It is likely to
require a number of years to develop the required
level of local epidemiological and policy knowl-
edge, data and financial information in order to
develop fully costed plans. Guidance from epide-
miologists and managers working in countries
with well- developed plans could support new TB
programme development elsewhere. Processes
to develop and approve disease management
plans may themselves be regulated (such as
under New Zealand’s Biosecurity Act 1993)
(New Zealand Government, 2016), and this can
provide for useful transparency, process disci-
pline and public or stakeholder benefit and
impact assessment.
15.2.8 Benefit–cost analysisA benefit–cost analysis helps planners and
stakeholders to evaluate identified strategic
options for a proposed TB programme. This usu-
ally requires the development of epidemiological
models, designed to represent the future out-
comes (normally between 20 to 50 years) of
selected strategic options. The models are used
to calculate the future annual benefits and costs,
based on present-day values, for the selected
time period. For each option, the annual calcu-
lated cost is subtracted from the annual benefit
for each year. The resulting value for each year is
then discounted to the present-day value and
summed for all years. This provides the net pres-
ent value (NPV) as an option. Ideally the option
of not having a TB programme, i.e. a ‘do noth-
ing’ case or something similar, should also be
modelled, together with its forecast annual
costs, benefits, and resulting NPV. NPV provides
a means of comparing the quantum difference
of each of the options when compared with the
‘do nothing’ option and allows them to be ranked
and evaluated (Livingstone et al., 2015b).
A major difficulty with TB benefit–cost
analyses is obtaining or deriving a monetary
value for the benefits. While programme costs
can usually be estimated with some accuracy,
benefits such as avoided disease-related produc-
tivity, product value or trade losses can be much
harder to quantify. Approaches to this problem
are likely to involve combinations of epidemio-
logical, livestock production and economic mod-
elling in order to project likely livestock infection
levels, and the resulting production, value and
trade losses, across a range of disease control
options and scenarios over time, and compare
these with projected programme delivery costs
(including within-farm cost such as for muster-
ing and yarding cattle for testing). Nevertheless,
if it is possible to assess these costs or the costs of
additional TB, then this provides a good basis for
evaluating a TB programme (Zinsstag et al.,
2006). The reliability of such comparisons may
be limited by availability of data on likely impacts
of various disease incidence levels on production
value, which may require estimation by industry
analysts (TBfree NZ, 2007).
A further problem arises through the long
time frames required to achieve significant TB
control or eradication objectives, which may
span several decades. Most of the benefits of such
programmes are only enjoyed well into the future,
whereas costs are incurred from the outset. Dis-
count rates used in conventional benefit–cost
analysis tend to give strong effect to short-term
costs while devaluing longer term benefits, which
may result in a negative NPV (Livingstone et al.,
2015b). In such situations, stakeholders will
need to make judgements as to whether a pro-
gramme will provide long lasting value, taking
account of the time to reach objectives and the
extent of the benefits when they eventually occur.
This may result in choosing the modelled option
with the least negative NPV. Stakeholders review-
ing options and the outcomes of modelled bene-
fit–cost analyses may seek a number of iterative
changes to plans, which can have flow-on