Framework to estimate the cost-effectiveness of the Genome Sequencing-based surveillance network: an integrated operational model-epidemiological model approach

Understanding how genomic surveillance capacity translates into population health outcomes is critical for designing effective pandemic response systems, yet the interaction between operational design and epidemiological dynamics remains insufficiently characterized. We develop an integrated analytical framework that links a whole-genome sequencing (WGS) - based surveillance network with a two - variant epidemiological transmission model to evaluate how surveillance operations influence variant detection, intervention timing, and health outcomes. The framework combines a modified susceptible - exposed - infectious - recovered - susceptible (SEIRS) model with a detailed operational representation of a centralized WGS surveillance network in India, incorporating sample collection, transport, batching, sequencing capacity, and reporting delays. We simulate 54 scenario combinations defined by three sequencing capacity levels, three sampling proportions, three variant emergence timings, and two variant profiles (high severity - high immune escape and low severity - low immune escape). Detection of a novel variant triggers a modeled intervention consisting of isolation of some diagnosed individuals, increased testing rates across disease states, and expanded access to hospitalization. Across simulations, the time from variant emergence to intervention implementation ranged from 73 to 351 days, depending on operational and epidemiological conditions. Increasing sampling proportion reduced detection time only when sequencing capacity was sufficient; under constrained capacity, higher sampling increased congestion and delayed detection. Expanding capacity from low to nominal levels substantially reduced turnaround times, with diminishing returns at higher capacity. Earlier detection consistently improved intervention effectiveness, with deaths averted ranging from 0.06% to 14.49% across scenarios. The cost per life - year saved ranged from INR 9,137 to INR 326,714 across all configurations, remaining below one to three times India ' s GDP per capita, consistent with established cost - effectiveness thresholds. These results demonstrate that the performance of genomic surveillance systems is jointly determined by operational and epidemiological dynamics. Effective surveillance design, therefore, requires coordinated optimization of sampling strategies and sequencing capacity to enable timely intervention and maximize population health benefits.