Economics of brucellosis


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Presented by Bassirou Bonfoh, Jyldyz Shigaeva and Bernd Steimann at a workshop on an integrated approach to controlling brucellosis in Africa, Addis Ababa, Ethiopia, 29-31 January 2013.

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  • Which productivity parameters in livestock? Fertility, milk Risk formulation: = Annual calving rate (1-(RiskPert(min, ml max)*(Prevalence)) Simulation of animal production over ten years with and without intervention Link production output to prices The same on the huma side Disability weight in DALYs, discounting
  • Economics of brucellosis

    1. 1. Economics of brucellosisBassirou Bonfoh, JyldyzShigaeva, Bernd Steimannwww.csrs.chWorkshop: An Integrated Approach to Controlling Brucellosis in Africa, AddisAbaba, 29-31 January 2013
    2. 2. Content1. Brucellosis research at CSRS2. Urbanisation of brucellosis3. Socio-economics of brucellosis4. Cases studies5. Area of capacity building6. Conclusions1/29/2013 Brucellosis in Africa 2
    3. 3. 1/29/2013 3Brucellosis in Africa
    4. 4. Brucellosis studies• Brucellosis control (massvaccination)– Mongolia, Kirghizstan• Brucellosis surveillance system(abattoir)– Senegal– Kirghizstan• Joint human-animalseroprevalence– Sahelian zone: Mali, Senegal– Humid zone: Togo, Côte d’Ivoire• Brucella strain mapping in WestAfrica
    5. 5. Evidence in value added fordecisionPeople torelateAdded value creationTackling healthcomplexitywith discipline& Knowledgefragmentation1/29/2013 5Brucellosis in Africa
    6. 6. Transformation ofproduction system1/29/2013 Brucellosis in Africa 6
    7. 7. Transformation of livestockproduction system• Herding• Marketing• Consumptionpatterns• Legal aspects• Geneticimprovement…
    8. 8. Context and institution matter1/29/2013 8Brucellosis in Africa
    9. 9. Urbanisation of brucellosis inAfrica• In Africa, livestock is a faster way to get the populationout of poverty (Alive, 2012)• Livestock is also a contreverse as far as green gasemission and soils/ pasture degradation areconcerned (Livestock long shadow)• Demand in protein is increasing due populationgrowth and income generation..• Livestock while contributing to food security andlivelihoods of the population can spill out diseases(majority of zoonoses are from animal origin).• The control is possible in the reservoir but there isimbalance resource allocation…unknown trueburden.1/29/2013 9Brucellosis in Africa
    10. 10. Socio-economics ofbrucellosisWhat is the burden?Public health of economic perspective1/29/2013 Brucellosis in Africa 10
    11. 11. Is brucellosis a priority?Is there evidence for interventiondecision ?• Contact network and interfaces• Estimates and data quality• Targeting intervention with epidemiologicalparameters (age groups, species, zones,…)• Cost of the disease, cost-effectiveness• Benefit sharing• Incentives (services) for actors1/29/2013 Brucellosis in Africa 11
    12. 12. Intervention in Mongolia• Test & slaughter 1960; Vaccination1970/80• 1990: Privatisation stop of surveillance• 1996-98 WHO planned vaccinationcampaign1/29/2013 12Human brucellosis00.00010.00020.00030.00040.00050.00060.00071970 1975 1980 1985 1990 1995 2000cumulativeincidenceend of socialist periodSheep brucellosis00.511.522.531965 1975 1985 1995prevalence%Brucellosis in Africa
    13. 13. Objectives of economics1. Estimate the damage of Brucellosis2. Cost effectiveness analysis to humanpopulation3. Estimate economic gain from all flockvaccination1/29/2013 13Brucellosis in Africa
    14. 14. Methods and datacollectionMethodology• patient based household survey• Inventory of existing data• Delphi study on human Brucellosis• Delphi study on animal Brucellosis• Theoretical deterministic model of animal tohuman Brucellosis transmission in Vensim®• development of @Risk ® -LDPS(FAO)-EXCEL ®spreadsheet (Ecozoo)1/29/2013 14Brucellosis in Africa
    15. 15. Selection ofalternatives• Current test an slaughter practice (noncompulsory culling of positive animals,no state compensation)• Whole herd vaccination programdeveloped (scenarios of 30-80%effectiveness)• 2 years all animals then only youngones: Rev1, S191/29/2013 15Brucellosis in Africa
    16. 16. Modelling: Epidemiologic andEconomical considerations• Animal to animal transmission dynamics• Simulation of interventions• Animal to human transmission• Need for underlying transmission model• Data quality– survey and reported data– method standardisation• Linkage of disease prevalence to– livestock productivity– health cost– linkage to prices
    17. 17. 1/29/2013 17Brucellosis in Africa
    18. 18. 1/29/2013 18Link of disease data to livestockproduction and human health cost• Human Health– Number of cases = Population * Exposure constant* Cumulative Incidence• Livestock productivity (only fertility and milkproduction)– Baseline Fertility: annual number of offspring per breeding female– Fertility= baseline fertility * (1 - (Beta-Pert (10%; 15%; 50%)* Prevalence ))Brucellosis in Africa
    19. 19. 1/29/2013 19ECOZOO V 1.0: outline**disease transmission simulation is not includedTablesDisease InterventionHuman HealthAnimal ProductionEconomicsGraphsCattle Productivity without interventionCattle Productivity with interventionSheep Productivity without interventionSheep Productivity with interventionGoat Productivity without interventionGoat Productivity with interventionLivestock production simulationsBrucellosis in Africa
    20. 20. 1/29/2013 20Summary of human healthcostInpatient costsOutpatient costsOut of pocket expenses for health careInformal Treatment costsLoss of incomeCoping costsBrucellosis in Africa
    21. 21. 1/29/2013 21Outcomes of Household studyEstimation of parametersMilk productionFertility rateMortality rateHerd structureBrucellosis in Africa
    22. 22. 1/29/2013 22Linking disease prevalence and livestockproductivity• What is the loss of livestock production from brucellosis• Main effect on fertility• Baseline fertility– Cattle 0.7 calves / cow / year; 1000 l milk / cow / year– Small ruminants 1.2 lambs / ewe / year• Livestock productivity Baseline Fertility: annual numberof offspring per breeding female– Fertility= baseline fertility *(1 – (0.15)*Prevalence )– Cattle 0.695, Small ruminants 1.195– Milkproduction = baseline * (1-0.15)*Prevalence)– Cattle 996 l milk / cow per yearBrucellosis in Africa
    23. 23. Distribution of benefits050000001000000015000000200000002500000030000000InterventioncostTotalHealthBenefitsPublichealthbenefitsPrivatehealthbenefitsHouseholdincomelossAgriculturalBenefitsTotalSocietalBenefitsSectorUS$1/29/2013 23Synoptic view of benefits and costs ofanimal brucellosis mass vaccination inMongoliaBrucellosis in Africa
    24. 24. Other socio-economic factors• Benefit & benefit distribution– Society, private, public health, agric sector• Costing interventions– Diagnostic, surveillance, control (laboratory, reagent,sampling, vaccine production)–• Research area– Fertility, productivity, household economics, DALY,strain for vaccine,modelling transmission1/29/2013 Brucellosis in Africa 24
    25. 25. Other case studies1/29/2013 Brucellosis in Africa 25
    26. 26. Surveillance in Kirghystan• Representative animal and humanbrucellosis prevalence and incidence– The study aimed to establish the brucellosissero-prevalence in livestock and theincidence of newly recorded humancases representative for Kyrgyzstan.– The sampling frame is a multistage clustersampling by levels of Oblast, Rayon, villageand households1/29/2013 26Brucellosis in Africa
    27. 27. Reducing surveillance cost• Dialog and intersectoralapproach• Capacity building (eg.quantitative epidemiology)• Lab analysis (mutualisation ofresources)• Cost of the representativeprevalence study ~60‘000Dollars–  method could reduce the cost ofthe national surveillance program3.32.4 2.815.6051015202530Sheep Goat Cattle HumanPrevalence%95%UCL95%LCLmean1/29/2013 27Brucellosis in Africa
    28. 28. Joint samplingPrise de sang par l’infirmierPrise de sang du bétail
    29. 29. Cross-sectional study TogoVillages randomlyselected 683 peoples, 596 bovines, 686 small ruminants in 25 villages (juin-juillet 2011) 464 transhumants from Burkina Faso (février-mars 2012)TOGOAbortion risque for Brucellosis: OR 3.8 (95%IC:1.2-12.1) (previous year adjusted for age)1/29/2013 29Brucellosis in Africa
    30. 30. Actors capacity buildingNew generation of researchers,practitionners and decision-makersBrucellosis in Africa1/29/2013 30
    31. 31. Brucellosis in AfricaAfrique OneAfrique OneMulti pathogens „zoonoses & other diseases“Approaches„discipline&Level“Institutions/UniversitiesCSRSEISMVLRZVNMIMRSUUAAMUSTIUG…Ecosystem-controlEpidemio multi-hotsEpidemio single-hostGeneticMolecularRabiesTBTrypanoEmerging Zoonoses„Afrique anglophone & francophone“ScaleAfrique One set up1/29/2013 31
    32. 32. New research perspectiveReversingthePublicHealthandeconomicviewonbrucellosisReversingthePublicHealthandeconomicviewonbrucellosis/29/2013 32Brucellosis in Africa
    33. 33. Conclusion• Situation better known in animal than in human• Test and slaughter policy is very not likely applicable(compensation, logistics…)• Option of mass vaccination in semi-intensive and intensiveproduction system– Reduce transmissio at a level te prevent human infection– Cutting transmission by pasteurisation, marketing system• Combining brucella vaccine with other dead vaccines….• Evidence based advocacy and policy influencing• Methodological tools on cost-benefit analysis of diseasecontrol based on brucellosis case study1/29/2013 Brucellosis in Africa 33
    34. 34. Brucellosis in Africa1/29/2013 34