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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

Boxplot representing the estimated total costs of CE in Spain in 2005 under the five scenarios.Legend: Lower line of the box represents the 25th percentile value. Middle line of the box represents the median. High line of the box represents 1.5 the 75th percentile value. The upper whisker represents the 75th percentile plus 1.5 the interquartile range. The lower whisker represents the 25th percentile minus 1.5 the interquartile range. The dots over the high lines represent values that lie outside the lower and upper whisker values (outliers).
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pntd-0003069-g003: Boxplot representing the estimated total costs of CE in Spain in 2005 under the five scenarios.Legend: Lower line of the box represents the 25th percentile value. Middle line of the box represents the median. High line of the box represents 1.5 the 75th percentile value. The upper whisker represents the 75th percentile plus 1.5 the interquartile range. The lower whisker represents the 25th percentile minus 1.5 the interquartile range. The dots over the high lines represent values that lie outside the lower and upper whisker values (outliers).

Mentions: The five scenarios run to estimate the total cost of CE in Alava for 2005 showed considerable variation, depending on assumptions made on the prevalence of asymptomatic cases and their associated productivity losses (Table 8 and Figure 3). When asymptomatic cases and productivity losses were excluded, the median cost was estimated at €61,864 (95%CI: €47,304–€76,590). All other scenarios had a lower credible interval superior to €61,000, but the lower whiskers (25th percentile minus 1.5 times the interquartile range) were similar among the models, with a value similar to the median under scenario 1 (see Figure 3). Scenarios 2 and 3, where productivity losses were assumed to follow a uniform distribution between 0% and 4%, resulted in the largest and most uncertain estimates.


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)

Boxplot representing the estimated total costs of CE in Spain in 2005 under the five scenarios.Legend: Lower line of the box represents the 25th percentile value. Middle line of the box represents the median. High line of the box represents 1.5 the 75th percentile value. The upper whisker represents the 75th percentile plus 1.5 the interquartile range. The lower whisker represents the 25th percentile minus 1.5 the interquartile range. The dots over the high lines represent values that lie outside the lower and upper whisker values (outliers).
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0003069-g003: Boxplot representing the estimated total costs of CE in Spain in 2005 under the five scenarios.Legend: Lower line of the box represents the 25th percentile value. Middle line of the box represents the median. High line of the box represents 1.5 the 75th percentile value. The upper whisker represents the 75th percentile plus 1.5 the interquartile range. The lower whisker represents the 25th percentile minus 1.5 the interquartile range. The dots over the high lines represent values that lie outside the lower and upper whisker values (outliers).
Mentions: The five scenarios run to estimate the total cost of CE in Alava for 2005 showed considerable variation, depending on assumptions made on the prevalence of asymptomatic cases and their associated productivity losses (Table 8 and Figure 3). When asymptomatic cases and productivity losses were excluded, the median cost was estimated at €61,864 (95%CI: €47,304–€76,590). All other scenarios had a lower credible interval superior to €61,000, but the lower whiskers (25th percentile minus 1.5 times the interquartile range) were similar among the models, with a value similar to the median under scenario 1 (see Figure 3). Scenarios 2 and 3, where productivity losses were assumed to follow a uniform distribution between 0% and 4%, resulted in the largest and most uncertain estimates.

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