Martin I. Meltzer

Re-evaluating the burden of rabies in Africa and Asia

OBJECTIVE To quantify the public health and economic burden of endemic canine rabies in Africa and Asia. METHODS Data from these regions were applied to a set of linked epidemiological and economic models. The human population at risk from endemic canine rabies was predicted using data on dog density, and human rabies deaths were estimated using a series of probability steps to determine the likelihood of clinical rabies developing in a person after being bitten by a dog suspected of having rabies. Model outputs on mortality and morbidity associated with rabies were used to calculate an improved disability-adjusted life year (DALY) score for the disease. The total societal cost incurred by the disease is presented. FINDINGS Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). Deaths due to rabies are responsible for 1.74 million DALYs lost each year (90% CI = 0.75-2.93). An additional 0.04 million DALYs are lost through morbidity and mortality following side-effects of nerve-tissue vaccines. The estimated annual cost of rabies is USD 583.5 million (90% CI = USD 540.1-626.3 million). Patient-borne costs for post-exposure treatment form the bulk of expenditure, accounting for nearly half the total costs of rabies. CONCLUSION Rabies remains an important yet neglected disease in Africa and Asia. Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society, with the major impact falling on those living in poor rural communities, in particular children.

Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance.

OBJECTIVE To determine the mortality, hospital stay, and total hospital charges and cost of hospitalization attributable to candidemia by comparing patients with candidemia with control-patients who have otherwise similar illnesses. Prior studies lack broad patient and hospital representation or cost-related information that accurately reflects current medical practices. DESIGN Our case-control study included case-patients with candidemia and their cost-related data, ascertained from laboratory-based candidemia surveillance conducted among all residents of Connecticut and Baltimore and Baltimore County, Maryland, during 1998 to 2000. Control-patients were matched on age, hospital type, admission year, discharge diagnoses, and duration of hospitalization prior to candidemia onset. RESULTS We identified 214 and 529 sets of matched case-patients and control-patients from the two locations, respectively. Mortality attributable to candidemia ranged between 19% and 24%. On multivariable analysis, candidemia was associated with mortality (OR, 5.3 for Connecticut and 8.5 for Baltimore and Baltimore County; P < .05), whereas receiving adequate treatment was protective (OR, 0.5 and 0.4 for the two locations, respectively; P < .05). Candidemia itself did not increase the total hospital charges and cost of hospitalization; when treatment status was accounted for, having received adequate treatment for candidemia significantly increased the total hospital charges and cost of hospitalization (

Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009

6,000 to

Impact of Dengue/Dengue Hemorrhagic Fever on The Developing World

29,000 and

Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)

3,000 to

Cost-effectiveness and potential impact of rotavirus vaccination in the United States.

22,000, respectively) and the length of stay (3 to 13 days). CONCLUSION Our findings underscore the burden of candidemia, particularly regarding the risk of death, length of hospitalization, and cost associated with treatment.

Estimates of US influenza-associated deaths made using four different methods.

Through July 2009, a total of 43,677 laboratory-confirmed cases of influenza A pandemic (H1N1) 2009 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million–5.7 million cases occurred, including 9,000–21,000 hospitalizations.

Public health impact of including two lineages of influenza B in a quadrivalent seasonal influenza vaccine

Publisher Summary This chapter focuses on the changing epidemiology of Dengue/Dengue Hemorrhagic Fever (DEN/DHF), estimates the global growth in the number of cases of DEN/DHF from 1955 to 1996, and uses these incidence data to estimate the global economic impact of this disease. Epidemic DEN/DHF has emerged as a global public health problem in the tropics in the past 20 years. This has been caused by the expanding geographic distribution of both the viruses and the principal mosquito vectors as a result of global demographic and societal changes. During this period, most tropical urban centers of the world have become hyperendemic, thus increasing the risk of epidemic transmission and the emergence of DHF. Despite this dramatic emergence of a new hemorrhagic disease, few estimates of the economic impact of DEN/DHF have been attempted. The lack of estimates of the economic impact of endemic DEN/DHF is important, because such estimates are needed by policy planners to help allocate limited resources for research, prevention, and control activities. Different model for evaluating the effect of the impact of DEN/DHF is provided in this chapter.

Introduction to health economics for physicians

To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Preventions Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.

Health Economics of Dengue: A Systematic Literature Review and Expert Panel's Assessment

OBJECTIVE. In February 2006, a safe, efficacious, orally administered pentavalent human-bovine reassortant rotavirus vaccine was licensed and recommended for routine immunization of all children in the United States. We assessed the health and economic impacts of a national rotavirus immunization program in the United States. METHODS. Monte Carlo cost-effectiveness analyses, from health care and societal perspectives, of vaccination of a hypothetical US birth cohort of 4010000 children monitored from birth to 59 months of age were performed. We compared the disease and economic burden of rotavirus infection in an unvaccinated cohort of children with one vaccinated at 2, 4, and 6 months with pentavalent human-bovine reassortant rotavirus vaccine. RESULTS. A routine rotavirus immunization program would prevent 13 deaths, 44000 hospitalizations, 137000 emergency department visits, 256000 office visits, and 1100000 episodes requiring only home care for children <5 years of age in the United States. Assuming costs of administration of