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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

Geographical distribution by municipalities of human CE cases (n = 144) residing in the province of Álava at the moment of diagnosis, 1991–2007.The region pointed out by the asterisk (Treviño) belongs to the adjacent Autonomous Region of Castile-Leon. The geographical location of the province of Álava in Spain is displayed in the top right corner of the figure.
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pntd-0003069-g002: Geographical distribution by municipalities of human CE cases (n = 144) residing in the province of Álava at the moment of diagnosis, 1991–2007.The region pointed out by the asterisk (Treviño) belongs to the adjacent Autonomous Region of Castile-Leon. The geographical location of the province of Álava in Spain is displayed in the top right corner of the figure.

Mentions: One hundred and fifty-four (154) patients were diagnosed with human CE during 1991–2007 in the two main hospitals of the province of Álava (Table 7). The male/female ratio was 1.05 and the age of cases ranged from 13 to 91 years (mean: 61.5; SD: 17.8). Only three subjects (1.9%) were of paediatric age (defined as ages from birth to 15 years of age), while patients over 60 years old accounted for 61.7% of cases. Most (57.8%) diagnosed cases were native to Álava. Only 4 individuals (2.6%) were born outside of Spain. The vast majority (144 cases, or 93.5%) of cases resided in the province at the moment of diagnosis, with 81.2% living in urban settlements in or around the capital Vitoria-Gasteiz. CE patients residing in rural areas were exclusively distributed alongside the eastern, southern, and western boundaries of the province bordering the ARs of Navarre, La Rioja, and Castile-León, respectively (Figure 2).


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)

Geographical distribution by municipalities of human CE cases (n = 144) residing in the province of Álava at the moment of diagnosis, 1991–2007.The region pointed out by the asterisk (Treviño) belongs to the adjacent Autonomous Region of Castile-Leon. The geographical location of the province of Álava in Spain is displayed in the top right corner of the figure.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0003069-g002: Geographical distribution by municipalities of human CE cases (n = 144) residing in the province of Álava at the moment of diagnosis, 1991–2007.The region pointed out by the asterisk (Treviño) belongs to the adjacent Autonomous Region of Castile-Leon. The geographical location of the province of Álava in Spain is displayed in the top right corner of the figure.
Mentions: One hundred and fifty-four (154) patients were diagnosed with human CE during 1991–2007 in the two main hospitals of the province of Álava (Table 7). The male/female ratio was 1.05 and the age of cases ranged from 13 to 91 years (mean: 61.5; SD: 17.8). Only three subjects (1.9%) were of paediatric age (defined as ages from birth to 15 years of age), while patients over 60 years old accounted for 61.7% of cases. Most (57.8%) diagnosed cases were native to Álava. Only 4 individuals (2.6%) were born outside of Spain. The vast majority (144 cases, or 93.5%) of cases resided in the province at the moment of diagnosis, with 81.2% living in urban settlements in or around the capital Vitoria-Gasteiz. CE patients residing in rural areas were exclusively distributed alongside the eastern, southern, and western boundaries of the province bordering the ARs of Navarre, La Rioja, and Castile-León, respectively (Figure 2).

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