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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

Estimated normalized regression coefficient showing the associations between uncertain parameters and total losses due to CE under scenario 1, Álava, 2005.
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pntd-0003069-g004: Estimated normalized regression coefficient showing the associations between uncertain parameters and total losses due to CE under scenario 1, Álava, 2005.

Mentions: Total livestock losses were estimated at €26,425 (95%CI 11,911–40,522), with indirect costs representing 93% of the total costs. Compared to human monetary losses, livestock costs represented 43% of the total costs in scenario 1 whereas they represented only 7% of the total costs in scenario 2, where the total median cost was estimated at €360,466 (95%CI: €76.424–€752,462). Figure 4 shows that most of the variation in the total costs in scenario 1 could be attributed to animal productivity estimates. In scenarios 2–5, the total costs depended largely on the percentage of productivity losses (normalized regression coefficients ranging from 0.82 in scenario 3 to 0.98 in scenario 4), followed by the estimated prevalence of asymptomatic cases in the population (normalized regression coefficients ranging from 0.43 in scenario 5 to 0.53 in scenario 3). The next parameter to contribute to the overall variation was the reduction in milk production with normalized regression coefficients of 0.03 in scenario 2 and 0.06 in scenario 5.


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)

Estimated normalized regression coefficient showing the associations between uncertain parameters and total losses due to CE under scenario 1, Álava, 2005.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0003069-g004: Estimated normalized regression coefficient showing the associations between uncertain parameters and total losses due to CE under scenario 1, Álava, 2005.
Mentions: Total livestock losses were estimated at €26,425 (95%CI 11,911–40,522), with indirect costs representing 93% of the total costs. Compared to human monetary losses, livestock costs represented 43% of the total costs in scenario 1 whereas they represented only 7% of the total costs in scenario 2, where the total median cost was estimated at €360,466 (95%CI: €76.424–€752,462). Figure 4 shows that most of the variation in the total costs in scenario 1 could be attributed to animal productivity estimates. In scenarios 2–5, the total costs depended largely on the percentage of productivity losses (normalized regression coefficients ranging from 0.82 in scenario 3 to 0.98 in scenario 4), followed by the estimated prevalence of asymptomatic cases in the population (normalized regression coefficients ranging from 0.43 in scenario 5 to 0.53 in scenario 3). The next parameter to contribute to the overall variation was the reduction in milk production with normalized regression coefficients of 0.03 in scenario 2 and 0.06 in scenario 5.

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