Abstract
The burden of human diseases in populations, or for an individual, is frequently estimated in terms of one of a number of Health Adjusted Life Years (HALYs). The Disability Adjusted Life Year (DALY) is a widely accepted HALY metric and is used by the World Health Organization and the Global Burden of Disease studies. Many human diseases are of animal origin and often cause ill health and production losses in domestic animals. The economic losses due to disease in animals are usually estimated in monetary terms. The monetary impact on animal health is not compatible with HALY approaches used to measure the impact on human health. To estimate the societal burden of zoonotic diseases that have substantial human and animal disease burden we propose methodology which can be accommodated within the DALY framework. Monetary losses due to the animal disease component of a zoonotic disease can be converted to an equivalent metric using a local gross national income per capita deflator. This essentially gives animal production losses a time trade-off for human life years. This is the time required to earn the income needed to replace that financial loss. This can then be assigned a DALY equivalent, termed animal loss equivalents (ALE), and added to the DALY associated with human ill health to give a modified DALY. This is referred to as the “zDALY”. ALEs could also be estimated using willingness-to-pay for animal health or survey tools to estimate the replacement time value for animals with high societal or emotional value (for example pets) that cannot be calculated directly using monetary worth. Thus the zDALY estimates the impact of a zoonotic disease to animal and human health. The losses due to the animal disease component of the modified DALY are straightforward to calculate. A number of worked examples such as echinococcosis, brucellosis, Q fever and cysticercosis from a diverse spectrum of countries with different levels of economic development illustrate the use of the zDALY indicator.
Highlights
An understanding of the economic and social impacts of diseases is central to the decision making process for disease control
In this case the African farmer would need nearly 4 weeks to replace that loss, whereas a farmer in an upper income country would require less than 1.5 days to replace a similar proportional loss. These impacts can be viewed as time that the livestock owner has been forced to sacrifice to replace the loss of his animal or to make up for the reduced output that a non-fatal animal disease causes. In this manuscript we propose a modified Disability Adjusted Life Year (DALY) for zoonotic disease, termed zDALY, that has an additional component, termed animal loss equivalents (ALE)
The most common signs of Q fever in animals are abortion during late pregnancy or weak offspring [34]. This results in the economic losses in affected animals used to estimate ALEs and contribute to the zDALY
Summary
An understanding of the economic and social impacts of diseases is central to the decision making process for disease control. Estimations of the monetary cost of disease effectively assign higher values to equivalent health outcomes in higher income countries than to the same outcomes in the low income countries [11] Because of these and the wider issues around valuing human life, non-monetary population health metrics such as disability adjusted life years (DALYs) have been developed to quantify the burden of premature death and disease and injury [12]. In this case the African farmer would need nearly 4 weeks to replace that loss, whereas a farmer in an upper income country would require less than 1.5 days to replace a similar proportional loss These impacts can be viewed as time that the livestock owner has been forced to sacrifice to replace the loss of his animal or to make up for the reduced output that a non-fatal animal disease causes. A number of worked examples on different zoonotic diseases from low, middle and upper income countries are used to illustrate this concept
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