Modeling uncertainty of estimated illnesses attributed to non-O157:H7 Shiga toxin-producing escherichia coli and its impact on illness cost.

Because of numerous reported foodborne illness cases due to non-O157:H7 Shiga toxin-producing Escherichia coli (STEC) bacteria in the United States and elsewhere, interest in requiring better control of these pathogens in the food supply has increased. Successfully putting forth regulations depends upon cost-benefit analyses. Policy decisions often depend upon an evaluation of the uncertainty of the estimates used in such an analysis. This article presents an approach for estimating the uncertainties of estimated expected cost per illness and total annual costs of non-O157 STEC-related illnesses due to uncertainties associated with (i) recent FoodNet data and (ii) methodology proposed by Scallan et al. in 2011. The FoodNet data categorize illnesses regarding hospitalization and death. We obtained the illness-category costs from the foodborne illness cost calculator of the U.S. Department of Agriculture, Economic Research Service. Our approach for estimating attendant uncertainties differs from that of Scallan et al. because we used a classical bootstrap procedure for estimating uncertainty of an estimated parameter value (e.g., mean value), reflecting the design of the FoodNet database, whereas the other approach results in an uncertainty distribution that includes an extraneous contribution due to the underlying variability of the distribution of illnesses among different sites. For data covering 2005 through 2010, we estimate that the average cost per illness was about $450, with a 98% credible interval of $230 to $1,000. This estimate and range are based on estimations of about one death and 100 hospitalizations per 34,000 illnesses. Our estimate of the total annual cost is about $51 million, with a 98% credible interval of $19 million to $122 million. The uncertainty distribution for total annual cost is approximated well by a lognormal distribution, with mean and standard deviations for the log-transformed costs of 10.765 and 0.390, respectively.

Cost of illness and disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157.

Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A second-order stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at €9.1 million and €4.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both €126 for diarrheal illness, both €25,713 for HUS, and €2.76 million and €1.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were €4,132 and €2,131, respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high.

Public health implications of a case of haemolytic-uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community.

The concomitant occurrence of a case of haemolytic-uraemic syndrome (HUS) and 62 cases of mild gastroenteritis in schools of a small rural community in southern Italy induced the health authorities to suspect a foodborne outbreak of shiga-toxin-producing Escherichia coli (STEC) infection. The schools were closed and the catering service involved was investigated. However, STEC were not isolated from the HUS case or from the 56 cases of gastroenteritis examined, and the HUS case and the outbreak of gastroenteritis were probably just coincidental. A retrospective cohort study failed to show any correlation with consumption of school meals and suggested that the outbreak probably started outside the school setting and then spread within the schools by person-to-person transmission. All the cases examined were negative for common enteric pathogens and the responsible agent for the cases of gastroenteritis was not identified. The concern raised in the small community by the occurrence of a severe case of HUS and the lack of a rapid epidemiological assessment excluding the occurrence of a STEC outbreak, turned an epidemic episode of mild gastroenteritis into a public health emergency with relevant socioeconomic consequences. Prompt intervention in outbreaks following timely and effective risk communication are crucial for taking the most appropriate control measures and avoiding the spread of fear and panic in the community.

[Hemolytic uremic syndrome (HUS): medical and social costs of treatment]. / Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas.

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.

Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas / Hemolytic uremic syndrome (HUS): medical and social costs of treatment

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.(AU)

Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas / Hemolytic uremic syndrome (HUS): medical and social costs of treatment

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.

Economic cost of illness due to Escherichia coli O157 infections in the United States.

The Centers for Disease Control and Prevention (CDC) has estimated that Shiga toxin-producing Escherichia coli O157 (0157 STEC) infections cause 73,000 illnesses annually in the United States, resulting in more than 2,000 hospitalizations and 60 deaths. In this study, the economic cost of illness due to O157 STEC infections transmitted by food or other means was estimated based on the CDC estimate of annual cases and newly available data from the Foodborne Diseases Active Surveillance Network (FoodNet) of the CDC Emerging Infections Program. The annual cost of illness due to O157 STEC was $405 million (in 2003 dollars), including $370 million for premature deaths, $30 million for medical care, and $5 million in lost productivity. The average cost per case varied greatly by severity of illness, ranging from $26 for an individual who did not obtain medical care to $6.2 million for a patient who died from hemolytic uremic syndrome. The high cost of illness due to O157 STEC infections suggests that additional efforts to control this pathogen might be warranted.

Escherichia coli O157:H7; an economic assessment of an outbreak.

BACKGROUND: The aim of the study was to assess the impact of an outbreak of Escherichia coli O157:H7 that occurred in 1994 in a rural community, with a population of approximately 107,000, to the west of Edinburgh. METHODS: The impact of the outbreak was assessed during the acute phase of the illness and in the subsequent 12 months. The method involved three surveys of confirmed cases using general practice notes, hospital records and interviews with cases. Key persons involved in the investigation and control of the outbreak were also interviewed. The impact of the illness on cases and their families was estimated and the resources used to treat cases and to control the outbreak were costed and long-term costs projected. RESULTS: There were 71 cases whose ages ranged from 7 months to 84 years. The mortality rate was 1.4 per hundred cases. There were 10 cases of haemolytic uraemic syndrome (HUS) and one case of thrombotic thrombocytopenia purpura (TTP). Two children were on long-term dialysis. Co-morbidity involving the immune system was associated with hospital admission. The illness lasted on average 6.9 weeks. Twenty-six per cent of cases reported symptoms 12 months later. The average cost per HUS case was 62,353 pound sterlings, the TTP case cost 21,422 pound sterlings, non-HUS and non-TTP cases cost 1,030 pound sterlings. The costs of investigating and controlling the outbreak were 171,848 pound sterlings. The costs of cases projected over 30 years were 11.9 million pound sterlings, or 168,032 pound sterlings per case. CONCLUSIONS: The impact on the health of cases was considerable and the costs were high. Every effort should be made to prevent the disease and to identify and control outbreaks quickly.