Economic effects of echinococcosis in a disease-endemic region of the Tibetan plateau

This report attempts to quantify the economic losses due to Echinococcus multilocularis and E. granulosus in Shiqu County, Sichuan, People's Republic of China, as well as illustrate the cost effectiveness of dog anthelmintic prophylaxis combined with a sheep and goat vaccination program in terms of disability-adjusted life years (DALYs) saved. We evaluated human losses associated with treatment costs and loss of income due to morbidity and mortality, in addition to production losses in livestock due to E. granulosus infection. Annual combined human and animal losses (95% confidence interval) is estimated to reach U.S.$218,676 (U.S.$189,850-247,871) if only liver-related losses in sheep, goats, and yaks are taken into account. This equates to approximately U.S.$3.47 per person annually or 1.4% of per capita gross domestic product. However, total annual losses can be nearly U.S.$1,000,000 if additional livestock production losses are assumed. Eventual prevention of 65-95% of annual losses due to cystic echinococcosis is suggested with proposed biannual dog anthelmintic prophylaxis and a sheep and goat vaccination program. Prevention of 9-50% of human alveolar echinococcosis-associated losses is suggested based on stochastic models for the current epidemiologic situation. The median estimated cost of the program would be approximately $56,000 per year, which is a fraction of the estimated combined livestock and human financial losses due to the disease. Overall cost for the proposed control program is within the World Health Organization second most cost-effective band of less than U.S.$150 per DALY averted. However, cost per DALY averted would be less than U.S.$25 dollars for the human health sector if cost sharing was implemented between the public health and agricultural sectors based on proportional benefit from control.