Abstract
Cystic echinococcosis (CE) is a globally distributed parasitic infection of humans and livestock. The disease is of significant medical and economic importance in many developing countries, including Iran. However, the socioeconomic impact of the disease, in most endemic countries, is not fully understood. The purpose of the present study was to determine the monetary burden of CE in Iran. Epidemiological data, including prevalence and incidence of CE in humans and animals, were obtained from regional hospitals, the scientific literature, and official government reports. Economic data relating to human and animal disease, including cost of treatment, productivity losses, and livestock production losses were obtained from official national and international datasets. Monte Carlo simulation methods were used to represent uncertainty in input parameters. Mean number of surgical CE cases per year for 2000–2009 was estimated at 1,295. The number of asymptomatic individuals living in the country was estimated at 635,232 (95% Credible Interval, CI 149,466–1,120,998). The overall annual cost of CE in Iran was estimated at US$232.3 million (95% CI US$103.1–397.8 million), including both direct and indirect costs. The cost associated with human CE was estimated at US$93.39 million (95% CI US$6.1–222.7 million) and the annual cost associated with CE in livestock was estimated at US$132 million (95% CI US$61.8–246.5 million). The cost per surgical human case was estimated at US$1,539. CE has a considerable economic impact on Iran, with the cost of the disease approximated at 0.03% of the country's gross domestic product. Establishment of a CE surveillance system and implementation of a control program are necessary to reduce the economic burden of CE on the country. Cost-benefit analysis of different control programs is recommended, incorporating present knowledge of the economic losses due to CE in Iran.
Highlights
Cystic echinococcosis (CE), a chronic disease caused by the larval form of the tapeworm Echinococcus granulosus, is one of the most important helminth-associated zoonoses globally [1,2]
Output variables were defined according to parameters involved in the estimation of direct and indirect costs associated with CE in humans and livestock intermediate hosts (Table 4)
Estimating the economic impact of a zoonotic disease is a way of quantifying the significance of the disease in both human and livestock populations
Summary
Cystic echinococcosis (CE), a chronic disease caused by the larval form of the tapeworm Echinococcus granulosus, is one of the most important helminth-associated zoonoses globally [1,2]. The parasite’s domestic life cycle involves livestock and dogs as the primary intermediate and definitive hosts, respectively. Canids harboring adult E. granulosus worms excrete eggs into the environment, where intermediate hosts become infected through ingestion of the eggs. Humans can act as aberrant intermediate hosts if they ingest infective parasite eggs either through contaminated food or directly from an infected canid. A cystic larval form (metacestode) gradually develops, most commonly in the liver or lungs. Clinical signs typically develop as a result of this spaceoccupying lesion exerting pressure on surrounding tissues. Rupture of the cyst and spillage of the contents may cause anaphylactic shock and secondary CE. In many parts of the world, including Iran, surgery remains the treatment of choice for most individuals suffering from CE [2]
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