Strategies to Control Classical Swine Fever: Cost and Risk Perspectives

The paper examines the importance of pig population density in the area of an outbreak of CSF for the spread of the disease and the choice of control measures. A sector-level market and trade model and a spatial, stochastic, dynamic epidemiological simulation model for the Netherlands were used. Outbreaks in sparsely and densely populated areas were compared under four different control strategies and with two alternative trade assumptions. Results indicate that the control strategy required by current EU legislation is enough to eradicate an epidemic starting in an area with sparse pig population. By contrast, additional control measures are necessary if the outbreak begins in an area with high pig population density. The economic consequences of using preventive slaughter rather than emergency vaccination as an additional control measure depend strongly on the reactions of trading partners. Reducing the number of animal movements significantly reduces the size and length of epidemics in areas with high pig density.Classical Swine Fever epidemics, pig population density, animal transport, emergency vaccination, preventive slaughter, the Netherlands, Farm Management,

Estimating the Costs and the Disease Burden Associated With Campylobacter Infections and Sequelae in the Netherlands

Campylobacter infections pose an important public health problem in the Netherlands. Approximately 79,000 persons per year are estimated to experience symptoms of acute gastroenteritis. Further annually some 1400 ReA cases, 60 GBS cases and 11 IBD cases are associated with a previous Campylobacter infection. Using a stochastic simulation model the disease burden and the cost-of-illness of Campylobacter infections and its sequelae were estimated. Estimates of the Campylobacter-associated disease burden and costs-of-illness were 1185 DALYs (90% C.I. 693 - 1845 DALYs) per year and some 21 million E (90% C.I. 10 - 38 million E) per year respectively.Campylobacter, sequelae, cost-of-illness, disease burden, Netherlands, Food Consumption/Nutrition/Food Safety,

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013.

Background and aimsThe Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25-1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control

Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country.

BACKGROUND: Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective. METHODS: The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed. RESULTS: For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from €4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to €9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of ≥0.41% and ≥0.22%, with ICERs below the Dutch cost-effectiveness reference value of €20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections. CONCLUSIONS: For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants

Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

Contains fulltext : 96770.pdf (publisher's version ) (Open Access)BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. We aimed to investigate which factors had a major impact on cost-effectiveness and were primarily responsible for the large differences in previously estimated cost-effectiveness ratios. METHODS: Based on updated data on health outcomes and cost estimates, we re-assessed the cost-effectiveness of routine paediatric rotavirus vaccination within the National Immunization Program for the Netherlands. Two consensus meetings were organised with national and international experts in the field to achieve consensus and resolve potential controversies. RESULTS: It was estimated that rotavirus vaccination in the Netherlands could avert 34,214 cases of rotavirus gastroenteritis in children aged less than 5 years. Notably, 2,779 hospitalisations were averted of which 315 were extensions of existing hospital stays due to nosocomial rotavirus infection. With a threshold varying from 20K euro - 50K euro per QALY and according to the base-case scenario, the full vaccination costs per child leading to cost-effectiveness was euro 57.76 -euro 77.71. Results were sensitive to the inclusion of potential vaccine induced herd protection, QALY losses and number of deaths associated with rotavirus gastroenteritis. CONCLUSIONS: Our economic analysis indicates that inclusion of rotavirus vaccination in the Dutch National Immunization Program might be cost-effective depending on the cost of the vaccine and the impact of rotavirus gastroenteritis on children's quality of life

Controlling Campylobacter in the chicken meat chain; Estimation of intervention costs

Campylobacter infections are a serious public health problem in the Netherlands. As a part of the CARMA project, this study focus on the estimation of the potential direct costs related to the implementation of various intervention measures to control campylobacters in the chicken meat chain. Costs were estimated using a second-order stochastic simulation model. Treating only positively tested flocks is far cheaper than treating all flocks. The implementation of equipment to reduce faecal leakage would be the cheapest, while irradiation would be costliness. However, indirect costs for the various interventions, if occurring, would be far higher than the estimated direct costs

Strategies to Control Classical Swine Fever: Cost and Risk Perspectives

The paper examines the importance of pig population density in the area of an outbreak of CSF for the spread of the disease and the choice of control measures. A sector-level market and trade model and a spatial, stochastic, dynamic epidemiological simulation model for the Netherlands were used. Outbreaks in sparsely and densely populated areas were compared under four different control strategies and with two alternative trade assumptions. Results indicate that the control strategy required by current EU legislation is enough to eradicate an epidemic starting in an area with sparse pig population. By contrast, additional control measures are necessary if the outbreak begins in an area with high pig population density. The economic consequences of using preventive slaughter rather than emergency vaccination as an additional control measure depend strongly on the reactions of trading partners. Reducing the number of animal movements significantly reduces the size and length of epidemics in areas with high pig density

Controlling Campylobacter in the chicken meat chain; Estimation of intervention costs

Campylobacter infections are a serious public health problem in the Netherlands. As a part of the CARMA project, this study focus on the estimation of the potential direct costs related to the implementation of various intervention measures to control campylobacters in the chicken meat chain. Costs were estimated using a second-order stochastic simulation model. Treating only positively tested flocks is far cheaper than treating all flocks. The implementation of equipment to reduce faecal leakage would be the cheapest, while irradiation would be costliness. However, indirect costs for the various interventions, if occurring, would be far higher than the estimated direct costs.Livestock Production/Industries,

Modelling the return on investment of preventively vaccinating healthcare workers against pertussis

Background: Healthcare workers (HCWs) are at particular risk of acquiring pertussis and transmitting the infection to high-risk susceptible patients and colleagues. In this paper, the return on investment (ROI) of preventively vaccinating HCWs against pertussis to prevent nosocomial pertussis outbreaks is estimated using a hospital ward perspective, presuming an outbreak occurs once in 10 years. Methods: Data on the pertussis outbreak on the neonatology ward in 2004 in the Academic Medical Center Amsterdam (The Netherlands) was used to calculate control costs and other outbreak related costs. The study population was: neonatology ward staff members (n = 133), parents (n = 40), neonates (n = 20), and newborns transferred to other hospitals (n = 23). ROI is presented as the amount of Euros saved in averting outbreaks by investing one Euro in preventively vaccinating HCWs. Sensitivity analysis was performed to study the robustness of the ROI. Results are presented at 2012 price level. Results: Total nosocomial pertussis outbreak costs were (sic)48,682. Direct control costs (i.e. antibiotic therapy, laboratory investigation and outbreak management control) were (sic)11,464. Other outbreak related costs (i.e. sick leave of HCWs; restrictions on the neonatology ward, savings due to reduced working force required) accounted for (sic)37,218. Vaccination costs were estimated at (sic)12,208. The ROI of preventively vaccinating HCWs against pertussis was 1:4, meaning 4 Euros could be saved by every Euro invested in vaccinating HCWs to avert outbreaks. ROI was sensitive to a lower vaccine price, considering direct control costs only, average length of stay of neonates on the neonatology ward, length of patient uptake restrictions, assuming no reduced work force due to ward closer and presuming more than one outbreak to occur in 10 years' time. Conclusion: From a hospital ward perspective, preventive vaccination of HCWs against pertussis to prevent nosocomial pertussis outbreaks results in a positive ROI, presuming an outbreak occurs once in 10 years