Improved methods to capture the total societal benefits of zoonotic disease control: Demonstrating the cost-effectiveness of an integrated control programme for Taenia solium, soil transmitted helminths and classical swine fever in northern Lao PDR.

BACKGROUND: Control and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People's Democratic Republic. METHOD: A cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. solium taeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs. FINDINGS: Using cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method. CONCLUSION: The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001067662.

The costs of preventive activities for exotic contagious diseases-A Danish case study of foot and mouth disease and swine fever.

The present paper provides an overview of the costs of preventive activities, currently undertaken in Denmark, related to foot and mouth disease (FMD) and classical and African swine fever (SF). Only costs held between outbreaks were included. Costs were divided into public costs and costs paid by the pig and cattle industries, respectively. Data were retrieved from multiple sources such as databases, legal documents, official statistics, yearly reports and expert opinions. As no previous studies have assessed such costs, data collection and estimation procedures were discussed and decided upon in a group of experts from universities, industry, and public authorities. The costs of each preventive activity were related to the type of activity, the number of times the activity was carried out and the share of costs that could be associated with FMD or SF. Uncertainty about parameters was incorporated in the analysis by assuming that the FMD/SF shares of costs as well as total costs for each activity could take on a most likely as well as a minimum and maximum value. A high degree of transparency was prioritized in the cost analysis, which enables reproducibility and easy access to conducting sensitivity analyses. A total of 27 FMD/SF preventive activities were identified. The estimated median (minimum-maximum) of total costs amounted to €32 (18-50) million in 2013. The single most costly FMD/SF related activity, amounting to €8 (5-13) million or 26% of total costs, was a national legal requirement to clean lorries immediately after transportation of live animals. The distribution of costs between stakeholders was estimated to be as follows: pig industry 63%, cattle industry 27%, and the public authorities 10%. Most of the activities focused on reducing the probability of spreading FMD/SF, while only a few activities were directed mainly towards reducing the probability of introduction. Legally required FMD/SF activities (mainly based on EU legislation) accounted for 60% of the activities, while FMD/SF related measures agreed on at sector level and measures implemented due to individual initiatives, such as farmer's investment in specially built delivery facilities, each accounted for 20%.

Implementation and validation of an economic module in the Be-FAST model to predict costs generated by livestock disease epidemics: Application to classical swine fever epidemics in Spain.

Be-FAST is a computer program based on a time-spatial stochastic spread mathematical model for studying the transmission of infectious livestock diseases within and between farms. The present work describes a new module integrated into Be-FAST to model the economic consequences of the spreading of classical swine fever (CSF) and other infectious livestock diseases within and between farms. CSF is financially one of the most damaging diseases in the swine industry worldwide. Specifically in Spain, the economic costs in the two last CSF epidemics (1997 and 2001) reached jointly more than 108 million euros. The present analysis suggests that severe CSF epidemics are associated with significant economic costs, approximately 80% of which are related to animal culling. Direct costs associated with control measures are strongly associated with the number of infected farms, while indirect costs are more strongly associated with epidemic duration. The economic model has been validated with economic information around the last outbreaks in Spain. These results suggest that our economic module may be useful for analysing and predicting economic consequences of livestock disease epidemics.

Economic Analysis of Classical Swine Fever Surveillance in the Netherlands.

Classical swine fever (CSF) is a highly contagious pig disease that causes economic losses and impaired animal welfare. Improving the surveillance system for CSF can help to ensure early detection of the virus, thereby providing a better initial situation for controlling the disease. Economic analysis is required to compare the benefits of improved surveillance with the costs of implementing a more intensive system. This study presents a comprehensive economic analysis of CSF surveillance in the Netherlands, taking into account the specialized structure of Dutch pig production, differences in virulence of CSF strains and a complete list of possible surveillance activities. The starting point of the analysis is the current Dutch surveillance system (i.e. the default surveillance-setup scenario), including the surveillance activities 'daily clinical observation by the farmer', 'veterinarian inspection after a call', 'routine veterinarian inspection', 'pathology in AHS', 'PCR on tonsil in AHS', 'PCR on grouped animals in CVI' and 'confirmatory PCR by NVWA'. Alternative surveillance-setup scenarios were proposed by adding 'routine serology in slaughterhouses', 'routine serology on sow farms' and 'PCR on rendered animals'. The costs and benefits for applying the alternative surveillance-setup scenarios were evaluated by comparing the annual mitigated economic losses because of intensified CSF surveillance with the annual additional surveillance costs. The results of the cost-effectiveness analysis show that the alternative surveillance-setup scenarios with 'PCR on rendered animals' are effective for the moderately virulent CSF strain, whereas the scenarios with 'routine serology in slaughterhouses' or 'routine serology on sow farms' are effective for the low virulent strain. Moreover, the current CSF surveillance system in the Netherlands is cost-effective for both moderately virulent and low virulent CSF strains. The results of the cost-benefit analysis for the moderately virulent CSF strain indicate that the current surveillance system in the Netherlands is adequate. From an economic perspective, there is little to be gained from intensifying surveillance.

Simulation of Cross-border Impacts Resulting from Classical Swine Fever Epidemics within the Netherlands and Germany.

The cross-border region of the Netherlands (NL) and the two German states of North Rhine Westphalia (NRW) and Lower Saxony (LS) is a large and highly integrated livestock production area. This region increasingly develops towards a single epidemiological area in which disease introduction is a shared veterinary and, consequently, economic risk. The objectives of this study were to examine classical swine fever (CSF) control strategies' veterinary and direct economic impacts for NL, NRW and LS given the current production structure and to analyse CSF's cross-border causes and impacts within the NL-NRW-LS region. The course of the epidemic was simulated by the use of InterSpread Plus, whereas economic analysis was restricted to calculating disease control costs and costs directly resulting from the control measures applied. Three veterinary control strategies were considered: a strategy based on the minimum EU requirements, a vaccination and a depopulation strategy based on NL and GER's contingency plans. Regardless of the veterinary control strategy, simulated outbreak sizes and durations for 2010 were much smaller than those simulated previously, using data from over 10 years ago. For example, worst-case outbreaks (50th percentile) in NL resulted in 30-40 infected farms and lasted for two to four and a half months; associated direct costs and direct consequential costs ranged from €24.7 to 28.6 million and €11.7 to 26.7 million, respectively. Both vaccination and depopulation strategies were efficient in controlling outbreaks, especially large outbreaks, whereas the EU minimum strategy was especially deficient in controlling worst-case outbreaks. Both vaccination and depopulation strategies resulted in low direct costs and direct consequential costs. The probability of cross-border disease spread was relatively low, and cross-border spread resulted in small, short outbreaks in neighbouring countries. Few opportunities for further cross-border harmonization and collaboration were identified, including the implementation of cross-border regions (free and diseased regions regardless of the border) in case of outbreaks within close proximity of the border, and more and quicker sharing of information across the border. It was expected, however, that collaboration to mitigate the market effects of an epidemic will create more opportunities to lower the impact of CSF outbreaks in a cross-border context.

Comparing the epidemiological and economic effects of control strategies against classical swine fever in Denmark.

In 2006, total Danish pork exports were valued at 3.8 billion euros, corresponding to approximately 5% of the total Danish exports, and an outbreak of a notifiable disease would have dramatic consequences for the agricultural sector in Denmark. Several outbreaks of classical swine fever (CSF) have occurred in Europe within the last decade, and different control strategies have been suggested. The objective of this study was to simulate the epidemiological and economic consequences of such control strategies in a CSF epidemic under Danish conditions with respect to herd demographics and geography and to investigate the effect of extra biosecurity measures on farms. We used InterSpread Plus to model the effect of nine different control strategies: the minimum measures required by the EU plus depopulation of contact herds (EUplus), extra depopulation of neighbouring herds, extra surveillance within the protection and surveillance zones, extra biosecurity in SPF herds-or in all herds, vaccination of all pigs in the 1 or 2 km zones using live vaccine as a protective measure (vaccination-to-kill), vaccination of all weaners and finishers in the 1 or 2 km zones using an E2 marker vaccine as a suppressive measure (vaccination-to-live). Each epidemic was simulated to start in four different index herds: production herds located in low, medium and high pig density areas, respectively; and a nucleus herd in an area of high pig density. For each control strategy and index case, we calculated the size and duration of the epidemic, the number of depopulated and/or vaccinated herds and animals, the control costs borne by the public and the pig industry, respectively, as well as the loss of exports associated with the epidemic. The simulations showed that the EUplus strategy is the most effective of the evaluated strategies with respect to limiting the size, duration and cost of the epidemic, regardless of the index case. However, regarding the number of slaughtered animals, the vaccination-to-live strategies appeared to be more effective. Epidemics become larger and last longer if the index case is a nucleus herd. This implies that biosecurity in nucleus herds is extremely important to avoid transmission of CSF to these herds. Simulations showed that a Danish CSF epidemic will be moderate in most cases and will include fewer than 10 cases and last less than 2 weeks on average. However, for some iterations, long-lasting and large epidemics were observed. Irrespective of the size and duration, an epidemic is expected to be very costly due to the export losses.

Simulated financial losses of classical swine fever epidemics in the Finnish pig production sector.

Rapid structural change and concentration of pig production in regions with most intensive production has raised concerns about whether the risk of large-scale disease losses has increased in Finland. This paper examines the pig industry's losses due to classical swine fever (CSF) epidemics. The work is based on economic and epidemiological models providing insights to the consequences of epidemics to infected and uninfected farms, government and meat processing. The economic analysis was carried out by use of a sector model, which simulated the recovery of pig production, starting from the recognition of the disease in the country and ending at a steady-state market equilibrium about 12 years later. The model explicitly took into account profit-maximising behaviour of producers and the effects of decrease in export demand. Epidemiological evidence suggests that under the current spatially diversified structure of Finnish pig farming and related industries, the probability of a severe disease epidemic counting dozens of infected farms is small. Even for epidemics considered large in Finland (5-33 infected farms) combined with a major reduction in export demand, the median loss was simulated to be only euro19.2 million. The majority of these losses were due to loss of exports corresponding almost 20% of pig meat production in Finland. While the current structure of pig farming in Finland incurs higher production costs than the most intensive structures in Europe, it also seems to decrease the probability of 'catastrophic' economic losses. The results suggest that the response of export markets and the number of uninfected farms affected by preventive measures are critical to the magnitude of losses, as they can amplify losses even if only few farms become infected.

Cost-effectiveness of measures to prevent classical swine fever introduction into The Netherlands.

Recent history has demonstrated that classical swine fever (CSF) epidemics can incur high economic losses, especially for exporting countries that have densely populated pig areas and apply a strategy of non-vaccination, such as The Netherlands. Introduction of CSF virus (CSFV) remains a continuing threat to the pig production sector in The Netherlands. Reducing the annual probability of CSFV introduction (P(CSFV)) by preventive measures is therefore of utmost importance. The choice of preventive measures depends not only on the achieved reduction of the annual P(CSFV), but also on the expenditures required for implementing these measures. The objective of this study was to explore the cost-effectiveness of tactical measures aimed at the prevention of CSFV introduction into The Netherlands. For this purpose for each measure (i) model calculations were performed with a scenario tree model for CSFV introduction and (ii) its annual cost was estimated. The cost-effectiveness was then determined as the reduction of the annual P(CSFV) achieved by each preventive measure (DeltaP) divided by the annual cost of implementing that measure (DeltaC). The measures analysed reduce the P(CSFV) caused by import or export of pigs. Results showed that separation of national and international transport of pigs is the most cost-effective measure, especially when risk aversion is assumed. Although testing piglets and breeding pigs by a quick and reliable PCR also had a high cost-effectiveness ratio, this measure is not attractive due to the high cost per pig imported. Besides, implementing such a measure is not allowed under current EU law, as it is trade restrictive.

Biosecurity practices on intensive pig production systems in Chile.

Chile eradicated classical swine fever (CSF) in April 1998, following a 17-year eradication programme. The authors describe biosecurity levels of pig farms in Chile after the eradication of CSF. A formal survey was administered to 50 large integrated pig farms, which represented almost 60% of the swine population. The main topics on the questionnaire were production, health management, biosecurity, insurance and information about CSF outbreaks in the past. Biosecurity practices were analysed according to the criteria stated by Barcelo and Marco in 1998. A scoring system to measure biosecurity was designed and pig farms were classified according to this score. An adjusted specific measure is discussed as a potential indicator of risk for disease infections. The authors explore associations between biosecurity herd size and insurance policy against CSF.

Simulated epidemiological and economic effects of measures to reduce piglet supply during a classical swine fever epidemic in The Netherlands.

The effects of additional measures adopted during a classical swine fever (CSF) epidemic to reduce piglet supply, namely, an insemination ban, abortion of sows and killing of young piglets, are studied using a stochastic, spatial, dynamic epidemiological simulation model of the pig sector in The Netherlands. The piglet supply derived from the epidemiological model is used as input for a sector-level market and trade model that simulates the pig market in The Netherlands. Changes in the economic welfare of different stakeholders are measured, as is the net welfare effect for the economy in The Netherlands. Sensitivity analysis is performed on parameters such as destruction capacity constraints and the duration of the high-risk period. Additional measures to reduce piglet supply are found to have no epidemiological impact, but they do involve larger economic welfare changes for stakeholders and a larger net welfare loss for the economy in The Netherlands. These findings do not support the use of the additional measures. Moreover, sensitivity analysis shows that such measures do not solve the problem of a shortage in rendering capacities.

The expected economic impact of selected exotic diseases on the pig industry of Australia.

The authors assess the expected economic impact of three exotic diseases on the pig industry of Australia. An integrated epidemiological/economic approach was used to assess the effects of classical swine fever, Nipah virus and porcine reproductive and respiratory syndrome. Scenarios involving either an epidemic event, in which the outbreaks were confined to selected regions and were eradicated, or an endemic situation, in which the diseases became established in Australia, were studied. Based only on loss of sales and disposal costs, epidemics resulted in regional losses in income of the order of AUS$10 million-AUS$30 million (16%-37%) depending on disease and region. If any of these diseases became established, opportunity losses in gross national pig income of 5%-11% per year would occur, with classical swine fever the most serious of the three diseases. Establishment of any of the diseases would lead to rapid structural change in the pig industry, with concomitant social and economic dislocation in regional Australia.

Epidemiology of classical swine fever in Germany in the 1990s.

In Germany, 424 outbreaks of CSF in domestic pigs and a great number of cases in wild boar were recorded between 1990 and 1998. Most of the federal states ('Bundesländer') were affected. Epidemiological data from field investigations combined with genetic typing allowed to distinguish seven unrelated epidemics and a number of sporadic outbreaks in domestic pigs. Detailed epidemiological data was available for 327 outbreaks. It was found that 28% of these were primary outbreaks. Most of them were due to indirect or direct contact to wild boar infected with CSF virus or swill feeding. Infected wild boar remain the main risk for domestic pigs. The most frequent sources of infection in secondary or follow up outbreaks were the trade with infected pigs, neighbourhood contacts to infected farms and other contacts via contaminated persons and vehicles, respectively. An increased risk of virus transmission from infected herds to neighbourhood farms was observed up to a radius of approximately 500m. More than two thirds of the infected herds were discovered due to clinical signs. About 20% were identified by epidemiological tracing on and back. These were scrutinised because contacts to infected herds were evident. In conclusion, tracing of contact herds and clinical examination combined with carefully targeted virological testing of suspicious animals is likely to be the most important measure to immediately uncover secondary outbreaks. Obligatory serological screening in the surveillance and the restriction zones do not seem to be efficient measures to detect follow-up outbreaks.

Economic aspects of the control of classical swine fever outbreaks in the European Union.

A framework for assessing the economic impact of classical swine fever (CSF) is presented, including an analysis of direct and indirect costs. Direct costs are divided into calculated costs, expenditure on control measures (payable costs) and costs due to financial transfers. The economic impact of current control strategies is described using practical examples. In most cases, the largest part of the direct costs is associated with transport standstill measures, of which approximately 45% are calculated costs. Alternative strategies, still based on non-vaccination offer a potential for reducing these costs. Various economic aspects of emergency vaccination are described using as an example, a hypothetical optimistic CSF case. In order to explore the impact of applying emergency vaccination using marker vaccines, additional research is required using simulation modelling. This research should include an assessment of risk and uncertainty with respect to calculating the epidemiological impact and the direct costs.

The economic evaluation of control and eradication of epidemic livestock diseases.

Many countries have implemented strategies to control and eradicate epidemic diseases. These strategies are usually based on either stamping-out or routine vaccination, sometimes complemented by emergency vaccination. The authors describe these strategies, using examples to illustrate each one. The economic evaluation of control and eradication of epidemic diseases is a complex matter. The authors provide further insight into this area by describing the various elements involved in both the 'non-outbreak periods' and the 'outbreak periods'. In addition, a system of categorisation of the direct costs and consequential losses is suggested for the calculation of costs and losses incurred by outbreaks. The economic impact of epidemic diseases on farmers and the livestock sector as a whole differs; these differences may be influenced by the control and eradication strategies applied. An attempt is made to provide a basic framework for economic evaluation on various economic levels.

The involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in western Europe.

In Western Europe, the control and eradication of contagious animal diseases have always been subject to government legislation. In the event of an outbreak, the principal policy is 'stamping-out' (depopulation) of the infected herd. The owner of the herd is usually awarded financial compensation. The authors provide an overview of the involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in Western Europe. In particular, developments within the European Union are described, as illustrated by a case study in the Netherlands. The economic consequences of a widespread epidemic of classical swine fever (hog cholera) in the Netherlands in 1997 are described. Evaluation of the epidemic demonstrated that special emphasis needs to be placed on factors such as the high-risk period, animal movement, the attitude of farmers towards risk and the structure of compensation. Epidemic disease insurance schemes are considered to be a possible alternative in alleviating certain financial losses caused by disease outbreaks.

[Risk increase and economic consequences of the introduction of contagious animal diseases in the Netherlands]. / Risico's op en economische gevolgen van insleep van besmettelijke dierziekten in Nederland.

The paper describes the development of the Monte Carlo simulation model VIRiS (Virus Introduction Risk Simulation) and the results obtained with this model. VIRiS simulates the introduction of Classical Swine Fever (CSF) and Foot and Mouth Disease (FMD) into the Netherlands. The model is based on objective information (research, databases), complemented by expert knowledge. Various questionnaire techniques (Conjoint Analysis, ELI) were used in order to elicit the experts' estimates in an objective and quantitative way. VIRiS provides information on the number of primary outbreaks in a certain period, their geographic location, causative risk factor, and causative country (or region). The information provided by VIRiS in combination with the outcome of models describing the spread and economic consequences of epidemics provides a tool that can be used to evaluate prevention strategies for their ability to reduce annual losses due to outbreaks.

A model to estimate the financial consequences of classical swine fever outbreaks: principles and outcomes.

A model is presented aimed at a financial analysis of a Classical Swine Fever outbreak. Financial consequences are calculated for affected parties, including governments (EU and national), farms, and related industries in the production chain. The model can be used to calculate the losses of a real outbreak as well as of a simulated one. In this article, the model is applied to the 1997/1998 outbreak of Classical Swine Fever in the Netherlands. Results show that total financial consequences of the outbreak are US $2.3 billion. Consequential losses for farmers and related industries are US $423 million and US $596 million respectively. Budgetary consequences for governments include less than 50% of the total losses calculated by the model. The model can be adapted easily to suit other diseases and countries.

Spatial and stochastic simulation to evaluate the impact of events and control measures on the 1997-1998 classical swine fever epidemic in The Netherlands. I. Description of simulation model.

The simulation model InterCSF was developed to simulate the Dutch Classical Swine Fever (CSF) epidemic of 1997-98 as closely as possible. InterCSF is a spatial, temporal and stochastic simulation model. The outcomes of the various replications give an estimate of the variation in size and duration of possible CSF-epidemics. InterCSF simulates disease spread from an infected farm to other farms through three contact types (animals, vehicles, persons) and through local spread up to a specified distance. The main disease-control mechanisms that influence the disease spread in InterCSF are diagnosis of the infected farms, depopulation of infected farms, movement-control areas, tracing, and pre-emptive slaughter. InterCSF was developed using InterSpread as the basis. InterSpread was developed for foot-and-mouth disease (FMD). This paper describes the process of modifying InterSpread into InterCSF. This involved changing the assumptions and mechanisms for disease spread from FMD to CSF. In addition, CSF-specific control measures based on the standard European Union (EU) regulations were included, as well as additional control measures that were applied during the Dutch epidemic. To adapt InterCSF as closely as possible to the Dutch 1997/98 epidemic, data from the real epidemic were analysed. Both disease spread and disease-control parameters were thus specifically based on the real epidemic. In general, InterSpread turned out to be a flexible tool that could be adapted to simulate another disease with relative ease. The most difficult were the modifications necessary to mimic the real epidemic as closely as possible. The model was well able to simulate an epidemic with a similar pattern over time for number of detected farms as the real outbreak; but the absolute numbers were (despite many relevant modifications) not exactly the same--but were within an acceptable range. Furthermore, the development of InterCSF provided the researchers with a better insight into the existing knowledge gaps. In part II (see the final paper in this issue), InterCSF was used to compare various control strategies as applied to this epidemic.