BACKGROUND: Effective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa. METHODOLOGY/PRINCIPAL FINDINGS: To assess the impact of the IDSR in Africa, we used pre- and post- IDSR meningococcal meningitis surveillance data from Burkina Faso (1996-2002 and 2003-2007). IDSR implementation was correlated with a median reduction of 2 weeks to peak of outbreaks (25th percentile 1 week; 75th percentile 4 weeks). IDSR was also correlated with a reduction of 43 meningitis cases per 100,000 (25th-40: 75th-129). Assuming the correlations between reductions in time to peak of outbreaks and cases are related, the cost-effectiveness of IDSR was $23 per case averted (25th-$30; 75th - cost saving), and $98 per meningitis-related death averted (25th-$140: 75th - cost saving). CONCLUSIONS/SIGNIFICANCE: We cannot absolutely claim that the measured differences were due to IDSR. We believe, however, that it is reasonable to claim that IDSR can improve the cost-effectiveness of public health surveillance.