The societal impact of bovine tuberculosis in select Asian countries

The economic Impact of bovine Tuberculosis in
Ethiopia and China: A comparative study to assess
the importance of the disease in Asia

Author & Presenter:
Adnan Choudhury

Co-Authors:
Jakob Zinsstag, Vanessa Racloz, Maxine Whittaker
The Economic Impact of Bovine Tuberculosis in Ethiopia and China 2012

Aims

o To demonstrate the importance of Bovine Tuberculosis
in developing nations – such as Ethiopia and China
• Particularly in Asia
o To demonstrate the importance of both economic
evaluations and the One Health Approach


Bovine Tuberculosis

o Mycobacterium bovis, is a zoonotic disease that is
prevalent across a wide range of nations
o Aerosol transmission between hosts (man, cattle,
wildlife)
o Causes TB Symptoms in humans
o In Animal emaciation, fever, obstructed
airways/vessels
o Countries such as the United Kingdom spend £100
million a year in control efforts against the spread of
bTB.
o Less developed nations are usually unable to afford
the steep costs of bTB control
o As such the disease spreads and becomes prevalent

Bovine Tuberculosis in Africa

o A study in Tanzania returned a rate of 1.3% for bTB positive
cases in individual animals while (Shirima et al. 2003)
o Nigeria reported 1.08% (Ibrahim et al. 2010).
o Herd prevalence up to 48%
o The incidence of TB in Ethiopia was 353/100000 in 2004
o Estimated 430,000 fatal cases in Africa due to TB (WHO
2011b).
• 3.1% attributable to bTB (Worldwide)
o High prevalence of consumption of unboiled milk


Bovine Tuberculosis in Asia

o 62% of global cases of BTB are reported in the Asia
region (Cosivi et al. 1998).
o Annual mortality due to all strains of tuberculosis in
South-East Asia is estimated by the WHO to be
480,000
o China, the fifth largest producer of milk
o Intensive production setups to cope with the
overwhelming demand
o Risk factor for aerosol transmission
o Evidence suggests that human results disease-
associated costs of TB equate to 91% of annual
household income, (Jackson et al. 2006).


Methods

o Animal Sector: LDPS2

o Adapted from the FAO by Zinnstag et al
o Adds economic layer on top of the livestock demographic
system
o Allows the simulation of changes to the NPV of livestock
industry due to the prevalence of Bovine Tuberculosis
o Human Sector: Decision-Tree

o Markov-Chain decision tree
o Probabilistic model that simulates the disease cycle,
interventions, treatment seeking etc
o Life tables used to simulate the life cycle of 1000
individuals
o Uncertainty analysis: Monte Carlo Simulation


Assumptions
Seeking rate
China - 2% too poor to start treatment
Treatment seeking assumed 100% for both countries due to lack of data,
tempered by adherence and too poor to start.
Adherence rate
China – 65% (literature)
Ethiopia – no data available, assumed to be 75% with a pert distribution
(low 0.5, high 0.9)
Prices
China – derived from literature review for human TB medication. After
weighted average of studies as well as conversion to USD, treatment
costs were assumed to be $US148.80 per person for a full
treatment.
Ethiopia – Very low treatment cost assumed – due to poor data available


Results – Animal Industry (Ethiopia)

$10,700,000,000
Average Annual NPV of Livestock Industry

$10,650,000,000

$10,600,000,000

$10,550,000,000

$10,500,000,000

$10,450,000,000

$10,400,000,000
0% 1% 2% 4% 8% 10% 15%
Prevalence


Results – Animal Industry (China)

$12,550,000,000
Average Annual NPV of Livestock Industry

$12,500,000,000

$12,450,000,000

$12,400,000,000

$12,350,000,000

$12,300,000,000

$12,250,000,000
0% 1% 2% 4% 8% 10% 15%
Prevalence


Results – Public Health (Ethiopia)

Per-Person Costs
Per-Person Cost of Disease to Society ($US) $0.14

$0.12

$0.10

$0.08

Mean
$0.06 LCI 95%
HCI 95%

$0.04

$0.02

$0.00
1% 2% 3% 8% 10%
% of bTB attributable to TB Cases


Results – Public Health (Ethiopia)

„Minimum‟ Cost to Society
$1,800,000.00

$1,600,000.00
'Minimum Cost of Disease to Society ($US)

$1,400,000.00

$1,200,000.00

$1,000,000.00
Mean
$800,000.00
LCI 95%
HCI 95%
$600,000.00

$400,000.00

$200,000.00

$0.00
1% 2% 3% 8% 10%


Results – Public Health (China)

Per-Person Costs
$2.50

$2.00
Cost to Society Per-Person ($US)

$1.50

Mean
LCI 95%
$1.00
HCI 95%

$0.50

$0.00
1% 2% 4.20% 8% 10%


Results – Public Health (China)

„Minimum‟ Cost to Society
$25,000,000.00

$20,000,000.00
"Minimum" Cost to Society ($US)

$15,000,000.00

LCI 95%
Mean
$10,000,000.00
HCI 95%

$5,000,000.00

$0.00
10% 8% 4.20% 2% 1%


Key Variables

o China
o Medical Costs***
o Adherence Rate
o Daily Wage Rate
o Ethiopia
o Daily Wage Rate
o Adherence Rate
o LDPS2 – Differences in influential variables reflect industry
demand
o China: Milk
o Ethiopia: Traction


Implications

o The pasteurization barrier
o In nations with systematic pasteurization of milk, there is
little to no human bTB
o In most developing nations, there is little or no
systematic pasteurization of milk
• Therefore, bTB remains a disease of significance to
human health


The One Health Difference

o Thus far, we have covered economics of zoonotic
diseases
• This has not been “One Health”
o One Health in the next step
o One health is when we evaluate the true societal costs
and benefits of pasteurization
• The reduction of animal and human costs
• The added value to dairy products and benefits to
farmers
• The social benefits of purchasing milk safely from
your local store

Thank you!


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