A Software Tool for Estimation of Burden of Infectious Diseases in Europe Using Incidence-Based Disability Adjusted Life Years

PLOS ONE, Dec 2019

The burden of disease framework facilitates the assessment of the health impact of diseases through the use of summary measures of population health such as Disability-Adjusted Life Years (DALYs). However, calculating, interpreting and communicating the results of studies using this methodology poses a challenge. The aim of the Burden of Communicable Disease in Europe (BCoDE) project is to summarize the impact of communicable disease in the European Union and European Economic Area Member States (EU/EEA MS). To meet this goal, a user-friendly software tool (BCoDE toolkit), was developed. This stand-alone application, written in C++, is open-access and freely available for download from the website of the European Centre for Disease Prevention and Control (ECDC). With the BCoDE toolkit, one can calculate DALYs by simply entering the age group- and sex-specific number of cases for one or more of selected sets of 32 communicable diseases (CDs) and 6 healthcare associated infections (HAIs). Disease progression models (i.e., outcome trees) for these communicable diseases were created following a thorough literature review of their disease progression pathway. The BCoDE toolkit runs Monte Carlo simulations of the input parameters and provides disease-specific results, including 95% uncertainty intervals, and permits comparisons between the different disease models entered. Results can be displayed as mean and median overall DALYs, DALYs per 100,000 population, and DALYs related to mortality vs. disability. Visualization options summarize complex epidemiological data, with the goal of improving communication and knowledge transfer for decision-making.

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A Software Tool for Estimation of Burden of Infectious Diseases in Europe Using Incidence-Based Disability Adjusted Life Years

January A Software Tool for Estimation of Burden of Infectious Diseases in Europe Using Incidence-Based Disability Adjusted Life Years Edoardo Colzani 0 1 Alessandro Cassini 0 1 Daniel Lewandowski 1 Marie-Josee J. Mangen 1 Dietrich Plass 1 Scott A. McDonald 1 Alies van Lier 1 Juanita A. Haagsma 1 2 Guido Maringhini 0 1 Alessandro Pini 0 1 Piotr Kramarz 0 1 Mirjam E. Kretzschmar 1 0 European Centre for Disease Prevention and Control (ECDC) , Solna , Sweden , 2 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht , Utrecht , The Netherlands , 3 NextPage Software Daniel Lewandowski, Zielona Gora, Poland, 4 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands, 5 Section Exposure Assessment and Environmental Health Indicators, German Environment Agency , Berlin , Germany 1 Editor: Donald R. Olson, New York City Department of Health and Mental Hygiene , UNITED STATES 2 Department of Global Health, Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America, 7 Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam , Rotterdam , the Netherlands The burden of disease framework facilitates the assessment of the health impact of diseases through the use of summary measures of population health such as DisabilityAdjusted Life Years (DALYs). However, calculating, interpreting and communicating the results of studies using this methodology poses a challenge. The aim of the Burden of Communicable Disease in Europe (BCoDE) project is to summarize the impact of communicable disease in the European Union and European Economic Area Member States (EU/EEA MS). To meet this goal, a user-friendly software tool (BCoDE toolkit), was developed. This stand-alone application, written in C++, is open-access and freely available for download from the website of the European Centre for Disease Prevention and Control (ECDC). With the BCoDE toolkit, one can calculate DALYs by simply entering the age group- and sexspecific number of cases for one or more of selected sets of 32 communicable diseases (CDs) and 6 healthcare associated infections (HAIs). Disease progression models (i.e., outcome trees) for these communicable diseases were created following a thorough literature - Funding: The European Centre for Disease Prevention and Control (ECDC), a publicly funded technical agency of the European Commission, funded the development of the BCoDE toolkit review of their disease progression pathway. The BCoDE toolkit runs Monte Carlo simulations of the input parameters and provides disease-specific results, including 95% uncertainty intervals, and permits comparisons between the different disease models entered. Results can be displayed as mean and median overall DALYs, DALYs per 100,000 population, and DALYs related to mortality vs. disability. Visualization options summarize complex epidemiological data, with the goal of improving communication and knowledge transfer for decision-making. software through the framework contract ECDC/ 2013/020 "Maintenance and further development of the BCoDE software tool" with NextPage Software Daniel Lewandowski. DL, self-employed at NextPage Software Daniel Lewandowski, developed the BCoDE toolkit software but did not have additional roles in the study design, data collection and analysis and decision to publish. He contributed to the preparation of the manuscript concerning the BCoDE toolkit software development technical description. The funder (ECDC) also provided support in the form of salaries for authors EC, AC and PK, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the `author contributions' section. Competing Interests: AC, EC and PK are employed by ECDC which funded the development of the BCoDE toolkit software. GM and AP were consultants with ECDC at the time of the design and development of the project. DL, self-employed by NextPage Software Daniel Lewandowski, is recipient of the project funding. This does not alter our adherence to PLOS ONE policies on sharing data and materials. No conflict of interest for MJJM, DP, SAM, AvL, JAH, MEK. Introduction Summary measures of population health (SMPH) are composite indicators that facilitate comprehensive and comparable quantitative assessments of health-related phenomena. Several measures have been developed for this purpose based on different assumptions, models and parameters [1±4]. One of the most common and prominent SMPH is the disability-adjusted life years (DALY), which has been largely used for global comparisons of the overall impact of diseases, injuries and risk factors [ 5, 6 ]. DALY is a composite metric quantifying the health losses measured in years by adding the number of years of (...truncated)


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Edoardo Colzani, Alessandro Cassini, Daniel Lewandowski, Marie-Josee J. Mangen, Dietrich Plass, Scott A. McDonald, Alies van Lier, Juanita A. Haagsma, Guido Maringhini, Alessandro Pini, Piotr Kramarz, Mirjam E. Kretzschmar. A Software Tool for Estimation of Burden of Infectious Diseases in Europe Using Incidence-Based Disability Adjusted Life Years, PLOS ONE, 2017, Volume 12, Issue 1, DOI: 10.1371/journal.pone.0170662