The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases

PLOS ONE, Dec 2019

In 2009, the European Centre for Disease Prevention and Control initiated the ‘Burden of Communicable Diseases in Europe (BCoDE)’ project to generate evidence-based and comparable burden-of-disease estimates of infectious diseases in Europe. The burden-of-disease metric used was the Disability-Adjusted Life Year (DALY), composed of years of life lost due to premature death (YLL) and due to disability (YLD). To better represent infectious diseases, a pathogen-based approach was used linking incident cases to sequelae through outcome trees. Health outcomes were included if an evidence-based causal relationship between infection and outcome was established. Life expectancy and disability weights were taken from the Global Burden of Disease Study and alternative studies. Disease progression parameters were based on literature. Country-specific incidence was based on surveillance data corrected for underestimation. Non-typhoidal Salmonella spp. and Campylobacter spp. were used for illustration. Using the incidence- and pathogen-based DALY approach the total burden for Salmonella spp. and Campylobacter spp. was estimated at 730 DALYs and at 1,780 DALYs per year in the Netherlands (average of 2005–2007). Sequelae accounted for 56% and 82% of the total burden of Salmonella spp. and Campylobacter spp., respectively. The incidence- and pathogen-based DALY methodology allows in the case of infectious diseases a more comprehensive calculation of the disease burden as subsequent sequelae are fully taken into account. Not considering subsequent sequelae would strongly underestimate the burden of infectious diseases. Estimates can be used to support prioritisation and comparison of infectious diseases and other health conditions, both within a country and between countries.

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The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases

et al. (2013) The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases. PLoS ONE 8(11): e79740. doi:10.1371/journal.pone.0079740 The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases Marie-Jose e J. Mangen 1 Dietrich Plass 1 Arie H. Havelaar 1 Cheryl L. Gibbons 1 Alessandro Cassini 0 1 Nikolai Mu hlberger 1 Alies van Lier 1 Juanita A. Haagsma 1 R. John Brooke 1 Taavi Lai 1 Martyn Kirk, The Australian National University, Australia 0 , Mirjam E. E. Kretzschmar 1 Institute for Health Development , Tallinn , Estonia); Scott McDonald (Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands); Laura Murianni (Institute of Public Health, Catholic University of the Sacred Heart , Rome , Italy; Social & Enviromental Statistics Department, National Institute of Statistics , Rome , Italy) ; Paulo Pinheiro (Department of Public Health Medicine, School of Public Health, University of Bielefeld , Bielefeld , Germany) ; Walter Ricciardi (Institute of Public Health, Catholic University of the Sacred Heart , Rome , Italy) ; Kristi Ru u tel (National Institute for Health Development , Tallinn , Estonia); Uwe Siebert (Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria; Institute for Technol- ogy Assessment and Department of Health Policy and Management, Harvard University , Boston, MA , USA) In 2009, the European Centre for Disease Prevention and Control initiated the 'Burden of Communicable Diseases in Europe (BCoDE)' project to generate evidence-based and comparable burden-of-disease estimates of infectious diseases in Europe. The burden-of-disease metric used was the Disability-Adjusted Life Year (DALY), composed of years of life lost due to premature death (YLL) and due to disability (YLD). To better represent infectious diseases, a pathogen-based approach was used linking incident cases to sequelae through outcome trees. Health outcomes were included if an evidence-based causal relationship between infection and outcome was established. Life expectancy and disability weights were taken from the Global Burden of Disease Study and alternative studies. Disease progression parameters were based on literature. Countryspecific incidence was based on surveillance data corrected for underestimation. Non-typhoidal Salmonella spp. and Campylobacter spp. were used for illustration. Using the incidence- and pathogen-based DALY approach the total burden for Salmonella spp. and Campylobacter spp. was estimated at 730 DALYs and at 1,780 DALYs per year in the Netherlands (average of 2005-2007). Sequelae accounted for 56% and 82% of the total burden of Salmonella spp. and Campylobacter spp., respectively. The incidence- and pathogen-based DALY methodology allows in the case of infectious diseases a more comprehensive calculation of the disease burden as subsequent sequelae are fully taken into account. Not considering subsequent sequelae would strongly underestimate the burden of infectious diseases. Estimates can be used to support prioritisation and comparison of infectious diseases and other health conditions, both within a country and between countries. - Funding: The BCoDE-project was funded by the European Centre for Disease Prevention and Control (ECDC, http://www.ecdc.europa.eu) as specific agreement No 1 to Framework Partnership Agreement GRANT/2008/003. The funders are also participating in the research project and are co-authors of the paper. Competing Interests: The authors have declared that no competing interests exist. " Membership of the Mouse Genome Sequencing Consortium is provided in the Acknowledgments. The disability-adjusted life year (DALY), a metric quantifying and combining the impact of premature death and non-fatal health outcomes resulting from disease, was jointly developed by the World Bank, Harvard School of Public Health and the World Health Organization for the Global Burden of Disease and injury (GBD) study [14]. DALYs were developed with the aim of supporting priority setting for healthcare and health research, to identify disadvantaged groups for targeted healthcare interventions, and to provide a comparable output measure for interventions, evaluations and planning [4]. Since their development and introduction in the World Development Report [5] DALYs have been widely used in both national and global disease burden estimations (e.g. [610]). In Europe, infectious diseases were estimated to account for less than 10% of the total burde (...truncated)


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Marie-Josée J. Mangen, Dietrich Plass, Arie H. Havelaar, Cheryl L. Gibbons, Alessandro Cassini, Nikolai Mühlberger, Alies van Lier, Juanita A. Haagsma, R. John Brooke, Taavi Lai, Chiara de Waure, Piotr Kramarz, Mirjam E. E. Kretzschmar, on behalf of the BCoDE consortium. The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases, PLOS ONE, 2013, Volume 8, Issue 11, DOI: 10.1371/journal.pone.0079740