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Cystic echinococcosis in the Province of Álava, North Spain: the monetary burden of a disease no longer under surveillance.

Carabin H, Balsera-Rodríguez FJ, Rebollar-Sáenz J, Benner CT, Benito A, Fernández-Crespo JC, Carmena D - PLoS Negl Trop Dis (2014)

Bottom Line: Direct costs (diagnosis, treatment, medical care in humans and condemnation of offal in livestock species) and indirect costs (productivity losses in humans and reduction in growth, fecundity and milk production in livestock) were modelled using the Latin hypercube method under five different scenarios reflecting different assumptions regarding the prevalence of asymptomatic cases and associated productivity losses in humans.The median total cost (95% credible interval) of CE in humans and animals in Álava in 2005 was estimated to range between €61,864 (95%CI%: €47,304-€76,590) and €360,466 (95%CI: €76,424-€752,469), with human-associated losses ranging from 57% to 93% of the total losses, depending on the scenario used.Our data provide evidence that CE is still very well present in Álava and incurs important cost to the province every year.

View Article: PubMed Central - PubMed

Affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.

ABSTRACT
Cystic echinococcosis (CE) is endemic in Spain but has been considered non-endemic in the province of Álava, Northern Spain, since 1997. However, Álava is surrounded by autonomous regions with some of the highest CE prevalence proportions in the nation, casting doubts about the current classification. The purpose of this study is to estimate the frequency of CE in humans and animals and to use this data to determine the societal cost incurred due to CE in the Álava population in 2005. We have identified epidemiological and clinical data from surveillance and hospital records, prevalence data in intermediate (sheep and cattle) host species from abattoir records, and economical data from national and regional official institutions. Direct costs (diagnosis, treatment, medical care in humans and condemnation of offal in livestock species) and indirect costs (productivity losses in humans and reduction in growth, fecundity and milk production in livestock) were modelled using the Latin hypercube method under five different scenarios reflecting different assumptions regarding the prevalence of asymptomatic cases and associated productivity losses in humans. A total of 13 human CE cases were reported in 2005. The median total cost (95% credible interval) of CE in humans and animals in Álava in 2005 was estimated to range between €61,864 (95%CI%: €47,304-€76,590) and €360,466 (95%CI: €76,424-€752,469), with human-associated losses ranging from 57% to 93% of the total losses, depending on the scenario used. Our data provide evidence that CE is still very well present in Álava and incurs important cost to the province every year. We expect this information to prove valuable for public health agencies and policy-makers, as it seems advisable to reinstate appropriate surveillance and monitoring systems and to implement effective control measures that avoid the spread and recrudescence of the disease.

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Related in: MedlinePlus

Annual incidence rate per 100,000 inhabitants of cystic echinococcosis in the province of Álava using hospital medical records (1991–2007), and the national surveillance system at the provincial (1982–1996) and national (1982–2007) levels.Legend: Full circles: Estimated annual incidence rate using the Álava Compulsory Notifiable Diseases system; Full squares: Estimated annual incidence rate using the National (Spain) Compulsory Notifiable Diseases system including data from all 17 Spanish autonomous regions (1982–1996) and the nine Spanish autonomous regions considered endemic after (1997–2007); Full triangles: Estimated annual incidence rate using the Hospital Medical Records from the two treating hospitals for CE in Álava. CND: Compulsory Notifiable Diseases system; HMR: Hospital Medical Records.
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pntd-0003069-g001: Annual incidence rate per 100,000 inhabitants of cystic echinococcosis in the province of Álava using hospital medical records (1991–2007), and the national surveillance system at the provincial (1982–1996) and national (1982–2007) levels.Legend: Full circles: Estimated annual incidence rate using the Álava Compulsory Notifiable Diseases system; Full squares: Estimated annual incidence rate using the National (Spain) Compulsory Notifiable Diseases system including data from all 17 Spanish autonomous regions (1982–1996) and the nine Spanish autonomous regions considered endemic after (1997–2007); Full triangles: Estimated annual incidence rate using the Hospital Medical Records from the two treating hospitals for CE in Álava. CND: Compulsory Notifiable Diseases system; HMR: Hospital Medical Records.

Mentions: Figure 1 shows available historical annual incidence rate of human CE in the province of Álava obtained from different sources, including revised HMR (1991–2007) and the official incidence of the disease (1991–1996) provided by the Compulsory Notifiable Diseases system (CND) of the national epidemiological surveillance network [13]. National official incidence rates (1982–2007) have also been included for reference [13]. Not surprisingly, HMR evidenced remarkably higher human CE rates than those reported by the CND, with an average 6-fold increase for the common period between 1991 and 1996. Similarly, a 4-fold increase was observed when the HMR figures were compared to the national official incidence rated for the period between 1997 and 2007.


Cystic echinococcosis in the Province of Álava, North Spain: the monetary burden of a disease no longer under surveillance.

Carabin H, Balsera-Rodríguez FJ, Rebollar-Sáenz J, Benner CT, Benito A, Fernández-Crespo JC, Carmena D - PLoS Negl Trop Dis (2014)

Annual incidence rate per 100,000 inhabitants of cystic echinococcosis in the province of Álava using hospital medical records (1991–2007), and the national surveillance system at the provincial (1982–1996) and national (1982–2007) levels.Legend: Full circles: Estimated annual incidence rate using the Álava Compulsory Notifiable Diseases system; Full squares: Estimated annual incidence rate using the National (Spain) Compulsory Notifiable Diseases system including data from all 17 Spanish autonomous regions (1982–1996) and the nine Spanish autonomous regions considered endemic after (1997–2007); Full triangles: Estimated annual incidence rate using the Hospital Medical Records from the two treating hospitals for CE in Álava. CND: Compulsory Notifiable Diseases system; HMR: Hospital Medical Records.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125306&req=5

pntd-0003069-g001: Annual incidence rate per 100,000 inhabitants of cystic echinococcosis in the province of Álava using hospital medical records (1991–2007), and the national surveillance system at the provincial (1982–1996) and national (1982–2007) levels.Legend: Full circles: Estimated annual incidence rate using the Álava Compulsory Notifiable Diseases system; Full squares: Estimated annual incidence rate using the National (Spain) Compulsory Notifiable Diseases system including data from all 17 Spanish autonomous regions (1982–1996) and the nine Spanish autonomous regions considered endemic after (1997–2007); Full triangles: Estimated annual incidence rate using the Hospital Medical Records from the two treating hospitals for CE in Álava. CND: Compulsory Notifiable Diseases system; HMR: Hospital Medical Records.
Mentions: Figure 1 shows available historical annual incidence rate of human CE in the province of Álava obtained from different sources, including revised HMR (1991–2007) and the official incidence of the disease (1991–1996) provided by the Compulsory Notifiable Diseases system (CND) of the national epidemiological surveillance network [13]. National official incidence rates (1982–2007) have also been included for reference [13]. Not surprisingly, HMR evidenced remarkably higher human CE rates than those reported by the CND, with an average 6-fold increase for the common period between 1991 and 1996. Similarly, a 4-fold increase was observed when the HMR figures were compared to the national official incidence rated for the period between 1997 and 2007.

Bottom Line: Direct costs (diagnosis, treatment, medical care in humans and condemnation of offal in livestock species) and indirect costs (productivity losses in humans and reduction in growth, fecundity and milk production in livestock) were modelled using the Latin hypercube method under five different scenarios reflecting different assumptions regarding the prevalence of asymptomatic cases and associated productivity losses in humans.The median total cost (95% credible interval) of CE in humans and animals in Álava in 2005 was estimated to range between €61,864 (95%CI%: €47,304-€76,590) and €360,466 (95%CI: €76,424-€752,469), with human-associated losses ranging from 57% to 93% of the total losses, depending on the scenario used.Our data provide evidence that CE is still very well present in Álava and incurs important cost to the province every year.

View Article: PubMed Central - PubMed

Affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.

ABSTRACT
Cystic echinococcosis (CE) is endemic in Spain but has been considered non-endemic in the province of Álava, Northern Spain, since 1997. However, Álava is surrounded by autonomous regions with some of the highest CE prevalence proportions in the nation, casting doubts about the current classification. The purpose of this study is to estimate the frequency of CE in humans and animals and to use this data to determine the societal cost incurred due to CE in the Álava population in 2005. We have identified epidemiological and clinical data from surveillance and hospital records, prevalence data in intermediate (sheep and cattle) host species from abattoir records, and economical data from national and regional official institutions. Direct costs (diagnosis, treatment, medical care in humans and condemnation of offal in livestock species) and indirect costs (productivity losses in humans and reduction in growth, fecundity and milk production in livestock) were modelled using the Latin hypercube method under five different scenarios reflecting different assumptions regarding the prevalence of asymptomatic cases and associated productivity losses in humans. A total of 13 human CE cases were reported in 2005. The median total cost (95% credible interval) of CE in humans and animals in Álava in 2005 was estimated to range between €61,864 (95%CI%: €47,304-€76,590) and €360,466 (95%CI: €76,424-€752,469), with human-associated losses ranging from 57% to 93% of the total losses, depending on the scenario used. Our data provide evidence that CE is still very well present in Álava and incurs important cost to the province every year. We expect this information to prove valuable for public health agencies and policy-makers, as it seems advisable to reinstate appropriate surveillance and monitoring systems and to implement effective control measures that avoid the spread and recrudescence of the disease.

Show MeSH
Related in: MedlinePlus