Economic welfare analysis of simulated control strategies for Classical Swine Fever epidemics

Keywords: Classical swine fever; contagious disease; epidemiological model; sector-level market and trade model; simulation; economic welfare analysis; densely and sparsely populated areas; supplementary animal welfare measures; the Netherlands. A sector-level and trade market model and a generic, spatial, temporal and stochastic epidemiological model are used to simulate the epidemiological and economic effects of different measures to control classical swine fever (CSF) epidemics in different regions in the Netherlands. The control measures include the current EU legislation (stamping-out infected herds; tracing contact herds and installing quarantine zones), preventive slaughtering or an emergency vaccination strategy with delayed destruction and intra-community trade as additional control measures. In addition, the effects of supplementary animal welfare measures to interrupt piglet production during a CSF epidemic are analysed. Different trade scenarios are simulated: a partial trade ban for the quarantine zones only or a total export ban on all Dutch live pigs. Aggregating the welfare changes of the different stakeholders (pig producers, consumers and government) provides results on the net welfare effect for the Dutch economy.Economic and epidemiological results suggest that measures to control CSF epidemics should be dependent on geographical circumstances. In a sparsely populated pig area, the measures defined by EU legislation are appropriate, whereas in a densely populated area additional control measures, e.g. emergency vaccination and/or preventive slaughter, are needed. The current political climate favours preventive slaughter for the Dutch situation. Furthermore, the option of supplementary animal welfare measures to interrupt piglet production during the epidemic is rejected on economic grounds. Results indicate that rendering capacities should be reserved for carcasses from infected and preventively slaughtered farms, and used to destroy pig carcasses slaughtered for animal welfare reasons only if capacity permits

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

Cost-effectiveness analysis of The Incredible Years Parenting Program as an indicated prevention of child conduct problem

Conduct problems in childhood affect the daily lives of children and their families and have serious economic implications for society. The Incredible Years parent program (IY) is a manualized behavioral parent training that aims to improve parenting skills in order to reduce conduct problems of children. We conducted a cost-effectiveness analysis of IY, compared to care-as-usual (CAU), in pre-schoolers at risk for a chronic pattern of conduct problems. In a case-control design with a two-year follow-up, we assessed intervention costs, use of public services (e.g., healthcare and special education), property damage, travel costs, and parental productivity losses. Conduct problems reduced in children in the IY condition, relative to CAU. From the public authorities perspective, the net costs to reduce the child’s conduct problems by one point of observed conduct problems (meaning a reduction of one disruptive behavior each 20 minutes) were €187. Taking the parents’ perspective and the societal perspective it was €88 and €155, respectively

A software tool for estimation of burden of infectious diseases in Europe using incidence-based disability adjusted life years

The burden of disease framework facilitates the assessment of the health impact of diseases through the use of summary measures of population health such as Disability- Adjusted Life Years (DALYs). However, calculating, interpreting and communicating the results of studies using this methodology poses a challenge. The aim of the Burden of Commu

Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): Rationale and design of a multicenter randomized clinical trial

Background: Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods: This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion: If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration:NCT02657044(Clinicaltrials.gov), registered January 8, 2016

Two major QTLs on chr. 2BL and 3BS influence grain yield in durum wheat across a broad range of water regimes

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs)

Background and aims: The 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: W

Evolution of costs of inflammatory bowel disease over two years of follow-up

Background: With the increasing use of anti-TNF therapy in inflammatory bowel disease (IBD), a shift of costs has been observed with medication costs replacing hospitalization and surgery as major cost driver. We aimed to explore the evolution of IBD-related costs over two years of follow-up. Methods and Findings: In total 1,307 Crohn's disease (CD) patients and 915 ulcerative colitis (UC) patients were prospectively followed for two years by three-monthly web-based questionnaires. Changes of healthcare costs, productivity costs and out-of-pocket costs over time were assessed using mixed model analysis. Multivariable logistic regression analysis was used to identify costs drivers. In total 737 CD patients and 566 UC were included. Total costs were stable over two years of follow-up, with annual total costs of € 7,835 in CD and € 3,600 in UC. However, within healthcare costs, the proportion of anti-TNF therapy-related costs increased from 64% to 72% in CD (p<0.01) and from 31% to 39% in UC (p < 0.01). In contrast, the proportion of hospitalization costs decreased from 19% to 13% in CD (p<0.01), and 22% to 15% in UC (p < 0.01). Penetrating disease course predicted an increase of healthcare costs (adjusted odds ratio (adj. OR) 1.95 (95% CI 1.02-3.37) in CD and age <40 years in UC (adj. OR 4.72 (95% CI 1.61-13.86)). Conclusions: BD-related costs remained stable over two years. However, the proportion of anti-TNFrelated healthcare costs increased, while hospitalization costs decreased. Factors associated with increased costs were penetrating disease course in CD and age <40 in UC