Assessing the burden of Taenia solium cysticercosis in Burundi, 2020.

BACKGROUND: Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs. METHODS: Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses. RESULTS: In Burundi, 4.26 million USD (95% UI, 1,858,308-8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3-75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9-89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25-168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370-16,716) and 61 (95% UI, 16-114), respectively. More than 2 zDALYs (95% UI, 1.1-3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3-2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3-1.5) due to porcine cysticercosis. CONCLUSIONS: This study provides evidence of a significant burden of T. solium cysticercosis for Burundi's population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.

DALYs, dollars and dogs: how best to analyse the economics of controlling zoonoses.

Decision-makers increasingly require comprehensive economic metrics summarising and comparing the benefits and costs of controlling zoonotic diseases. The impact of disease in people is conventionally quantified in non-monetary terms, usually a disability-adjusted life year (DALY), whereas the losses due to disease in animals, particularly livestock, are quantified in monetary terms. The potential for the development of a non-monetary metric for ill health in animals, based on life years lost and disability, is discussed and rejected. Within and across animal species and livestock production systems, maximising life spans is not a consistent goal and morbidity/disabilities have very different weights and often lead to culling. By relating livestock losses to a measure of national income forgone, the recently developed alternative of converting monetary losses due to livestock illness into an animal loss equivalent (ALE) provides a viable solution. Based on this, the literature on the economics of controlling zoonoses is revisited and four options for quantifying and comparing benefits and costs are examined and illustrated using numerical examples. These are i) the simplistic grouping of all monetary elements and their comparison to DALYs averted (described as the aggregate net cost method), ii) the separable costs method, iii) the use of ALEs to convert all benefits to a non-monetary equivalent, termed the zoonotic DALY (zDALY), or iv) the use of a full monetary cost-benefit analysis, based on converting DALYs to a monetary equivalent. The strengths and weaknesses of each are discussed. For effective prioritisation and decision-making, it is vital that an analytical approach is widely adopted which yields consistent results and which supports the control of zoonoses.

Les décideurs politiques sont de plus en plus dépendants de méthodes exhaustives de mesure économique permettant de synthétiser et de comparer les avantages et les coûts de la lutte contre les zoonoses. Par convention, l'impact des maladies humaines est quantifié en des termes non monétaires, à savoir, le plus souvent, en « années de vie corrigées de l'incapacité ¼ (DALY), tandis que les pertes dues aux maladies animales, en particulier celles affectant les animaux d'élevage, sont quantifiées en termes monétaires. Dans cet article, les auteurs envisagent (et réfutent) la possibilité de mettre en oeuvre un système de mesure non monétaire des problèmes sanitaires chez les animaux qui soit basé sur les années de vie perdues ou d'incapacité. La longévité n'est pas un objectif uniformément recherché dans tous les systèmes de production, ni pour toutes les espèces animales, voire pour tous les individus au sein d'une même espèce, et la morbidité et l'incapacité représentent des fardeaux très variables, conduisant souvent à l'abattage. Parce qu'elle relie les pertes animales à une mesure de la réduction du revenu intérieur entraînée, la récente proposition de convertir les pertes monétaires dues aux maladies du bétail en un « équivalent pertes animales ¼ (indicateur ALE : animal loss equivalent) constitue une solution viable. À partir de ces considérations, les auteurs examinent la littérature dédiée aux aspects économiques de la lutte contre les zoonoses en détaillant quatre méthodes possibles pour en quantifier et comparer les avantages et les coûts, avec des exemples chiffrés. Ces possibilités sont : i) le simple regroupement de tous les éléments monétaires et leur comparaison en termes de DALY évitées (méthode dite de la présentation agrégée des coûts nets) ; ii) la méthode des coûts séparables ; iii) l'utilisation d'un indicateur ALE pour convertir l'ensemble des bénéfices en leur équivalent non monétaire, désigné sous le terme de DALY zoonotique (zDALY) ; iv) le recours à une analyse monétaire coûts-avantages exhaustive, après avoir converti les DALY en leur équivalent monétaire. Les auteurs font ressortir les atouts et les faiblesses de chacune de ces méthodes. La priorisation et la prise de décisions gagneront en efficacité si les décideurs adoptent et appliquent largement une approche analytique permettant d'obtenir des résultats cohérents et de renforcer la lutte contre les zoonoses.

Cada vez más, las instancias decisorias necesitan parámetros econométricos integrales, que sirvan para sintetizar y comparar los costos y beneficios de la lucha contra enfermedades zoonóticas. Convencionalmente, los efectos de una enfermedad en las personas se cuantifican en términos no monetarios, por lo general en forma de «años de vida ajustados en función de la discapacidad¼ (AVAD), mientras que las pérdidas inducidas por las enfermedades en animales, en particular el ganado, se cuantifican en valores monetarios. Los autores examinan y descartan la posible definición de parámetros no monetarios, basados en los años de vida perdidos y en la discapacidad, para cuantificar problemas zoosanitarios. Con independencia de la especie animal o el sistema de producción ganadera de que se trate, el de lograr una longevidad máxima no es un objetivo habitual, y los niveles de morbilidad o discapacidad, que suelen desembocar en el sacrificio sanitario, tienen un peso muy variable. En fechas recientes ha aparecido una alternativa que, al establecer una relación entre las pérdidas de ganado y una medida de la renta nacional prevista, ofrece una solución viable: se trata de convertir las pérdidas monetarias causadas por enfermedades del ganado en un «equivalente a las pérdidas animales¼ (animal loss equivalent: ALE). Partiendo de esta idea, los autores repasan la bibliografía sobre la economía de la lucha contra las zoonosis y examinan cuatro opciones para cuantificar y comparar beneficios y costos, ilustrándolas con ejemplos numéricos. Se trata de las siguientes: i) el simplificador procedimiento de agrupar todos los elementos monetarios y compararlos con los AVAD evitados (método que describen como del «costo agregado neto¼); ii) el método de los costos específicos; iii) el uso de «equivalentes a las pérdidas animales¼ para convertir todos los beneficios en un equivalente no monetario que denominan AVAD por zoonosis; y iv) el uso de un análisis monetario completo de la relación entre beneficios y costos, basado en la conversión de los AVAD en un equivalente monetario. A continuación examinan los puntos fuertes y débiles de cada uno de esos métodos, y concluyen que para fijar prioridades y adoptar decisiones con eficacia es vital aplicar de forma generalizada un mismo planteamiento analítico, que arroje resultados coherentes y ayude así a combatir las zoonosis.

Assessment of the burden of rabies in one health approach control program in Ketapang District Indonesia: Using zDALY.

Background: Ketapang District, located in West Kalimantan, is a region where rabies is endemic. The first human death from rabies was reported in 2014 and the problem persists to this day. In response, the government has implemented the one health approach to control rabies since 2017. This study aimed to assess the disease burden of rabies control using zDALY metrics. Methods: The zoonotic burden for human and animal was measured by developing Zoonotic Disability-Adjusted Life Years (zDALY), which combines DALY and local values of animals and their products, considering animal morbidity and mortality due to the disease (Animal Loss Equivalent/ALE). Data were gathered through interviews with victims or their families, dog owners, and secondary data from the Animal Husbandry Service, and the District Health Office. Results: Before implementing the one health approach, the zDALY value was 1,561.22 person-years (the zDALY rate: 109.53 years/100,000 people). After the intervention, the zDALY value was 1,808.86 person-years (the zDALY rate: 86.62 years/100,000 people). Conclusions: This reduction in the zDaly rate indicates that rabies control through the one health approach in Ketapang District was effective in alleviating the disease burden caused by rabies.