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dc.contributor.authorMonge, Susana
dc.contributor.authorPijnacker, Roan
dc.contributor.authorvan Pelt, Wilfrid
dc.contributor.authorFranz, Eelco
dc.contributor.authorKortbeek, Laetitia M
dc.contributor.authorMangen, Marie-Josée J
dc.date.accessioned2019-03-22T12:08:22Z
dc.date.available2019-03-22T12:08:22Z
dc.date.issued2019-01-01
dc.identifier.issn1932-6203
dc.identifier.pmid30861047
dc.identifier.doi10.1371/journal.pone.0213752
dc.identifier.urihttp://hdl.handle.net/10029/622927
dc.description.abstractBurden of disease (BoD) estimations are increasingly used to prioritize public health interventions. Previous Cryptosporidium BoD models accounted only for acute episodes, while there is increasing evidence of long-term manifestations. Our objective was to update Cryptosporidium BoD and cost-of-illness (COI) models and to estimate BoD and COI for the Netherlands in years 2013-2017. We performed a scoping literature review and drew an outcome tree including long-term manifestations for which sufficient evidence was found, such as recurrent diarrhea and joint pain. We chose the Disability-Adjusted Life Year (DALY) metric to synthesize years of life lost due mortality (YLLs) and years lived with disability due to non-fatal outcomes (YLDs). For the costs, we adopted a societal perspective accounting for direct healthcare costs, patient costs and productivity losses. Uncertainty was managed using Latin Hypercube sampling (30,000 iterations). In the Netherlands in 2017, we estimated 50,000 Cryptosporidium cases (95% uncertainty interval (UI): 15,000-102,000), 7,000 GP visits, 300 hospitalizations and 3 deaths, resulting in 137 DALYs (95%UI: 54-255) and €19.2 million COI (95%UI: €7.2 million- €36.2 million). Estimates were highest for 2016 (218 DALYs and €31.1 million in COI), and lowest in 2013 (100 DALYs and €13.8 million in COI). Most of the BoD was attributable to YLD (≈80% of DALYs). The most important cost was productivity losses (≈90% of total COI). Long-term manifestations, including recurring diarrhea and joint pain, accounted for 9% of the total DALYs and 7% of the total COI. Current evidence supports the inclusion of long-term manifestations in Cryptosporidium models, which contribute close to 10% of the total DALYs and costs. This may be an underestimation, as we were conservative in our assumptions. Cryptosporidium should be considered a priority organism with respect to public health surveillance, even in industrialized countries with high hygiene standards.en_US
dc.language.isoenen_US
dc.titleAccounting for long-term manifestations of Cryptosporidium spp infection in burden of disease and cost-of-illness estimations, the Netherlands (2013-2017).en_US
dc.typeArticleen_US
dc.identifier.journalPlos One 2019; 14(3):e0213752en_US
dc.source.journaltitlePloS one


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