Cost-benefit analysis of intervention policies for prevention and control of brucellosis in India

<div><p>Background</p><p>Brucellosis is endemic in the bovine population in India and causes a loss of US$3·4 billion to the livestock industry besides having a significant human health impact.</p><p>Methods</p><p>We developed a stochastic simulation model to estimate the impact of three alternative vaccination strategies on the prevalence of <i>Brucella</i> infection in the bovine populations in India for the next two decades: (a) annual mass vaccination only for the replacement calves and (b) vaccination of both the adult and young population at the beginning of the program followed by an annual vaccination of the replacement calves and, (c) annual mass vaccination of replacements for a decade followed by a decade of a test and slaughter strategy.</p><p>Findings</p><p>For all interventions, our results indicate that the prevalence of <i>Brucella</i> infection will drop below 2$ 4·16 billion for intervention (a), US $8·31 billion for intervention (b) and, US$ 4·26 for intervention (c). For buffalo, the corresponding NPVs were US $8·77 billion, US$ 13·42 and, US $ 7·66, respectively. The benefit cost ratio (BCR) for the first, second and the third intervention for cattle were 7·98, 10·62 and, 3·16, respectively. Corresponding BCR estimates for buffalo were 17·81, 21·27 and, 3·79, respectively.</p><p>Conclusion</p><p>These results suggest that all interventions will be cost-effective with the intervention (b), i.e. the vaccination of replacements with mass vaccination at the beginning of the program, being the most cost-effective choice. Further, sensitivity analysis revealed that all interventions will be cost-effective even at the 50% of the current prevalence estimates. The results advocate for the implementation of a disease control program for brucellosis in India.</p></div

Net present value (NPV) and benefit-cost ratio (BCR) of a brucellosis intervention program in cattle (first 20 years) in India.

<p>Scenario 1 –Vaccination of replacements; Scenario 2 –Vaccination for all at once followed by vaccination of replacements; Scenario 3 –Vaccination of replacements for the first 10 years followed by the test and cull for remaining 10 years.</p

Parameters used for benefit-cost analysis of intervention strategies to control brucellosis in bovine populations, India (1 US $ = Rs. 60/-).

<p>Parameters used for benefit-cost analysis of intervention strategies to control brucellosis in bovine populations, India (1 US $ = Rs. 60/-).</p

Net present value (NPV) and benefit-cost ratio (BCR) of a brucellosis intervention program in buffalo (first 20 years) in India.

<p>Scenario 1 –Vaccination of replacements; Scenario 2 –Vaccination for all at once followed by vaccination of replacements; Scenario 3 –Vaccination of replacements for the first 10 years followed by the test and cull for remaining 10 years.</p

Changes in prevalence of brucellosis in buffaloes after the implementation of intervention programmes.

<p>Changes in prevalence of brucellosis in buffaloes after the implementation of intervention programmes.</p

Hierarchical true prevalence, risk factors and clinical symptoms of tuberculosis among suspects in Bangladesh.

BackgroundThe study was aimed to estimate the true prevalence of human tuberculosis (TB); identify risk factors and clinical symptoms of TB; and detect rifampicin (RIF) sensitivity in three study areas of Bangladesh.MethodsThe cross-sectional study was conducted in three Bangladesh districts during 2018. Potential risk factors, clinical symptoms, and comorbidities were collected from 684 TB suspects. Sputum specimens were examined by LED microscopy. TB hierarchical true prevalence, risk factors and clinical symptoms were estimated and identified using a Bayesian analysis framework. Rifampicin sensitivity of M. tuberculosis (MTB) was detected by GeneXpert MTB/RIF assay.ResultsThe median TB true prevalence was 14.2% (3.8; 34.5). Although overall clustering of prevalence was not found, several DOTS centers were identified with high prevalence (22.3% to 43.7%). Risk factors for TB identified (odds ratio) were age (> 25 to 45 years 2.67 (1.09; 6.99), > 45 to 60 years 3.43 (1.38; 9.19) and individuals in families/neighborhoods where a TB patient(s) has (ve) already been present (12.31 (6.79; 22.60)). Fatigue, night sweat, fever and hemoptysis were identified as important clinical symptoms. Seven of the GeneXpert MTB/RIF positive sputum specimens (65) were resistant to rifampicin.ConclusionsAbout one in every seven TB suspects was affected with TB. A number of the TB patients carry multi drug resistant MTB. Hierarchical true prevalence estimation allowed identifying DOTS centers with high TB burden. Insights from this study will enable more efficient use of DOTScenters-based TB surveillance to end the TB epidemic in Bangladesh by 2035

Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results