title: Echinococcosis in Tunisia: a cost analysis.
abstract: Echinococcus granulosus infection is a preventable zoonosis of human and veterinary public health importance in Tunisia. We aimed to comprehensively quantify human and animal echinococcosis losses in Tunisia. Itemized cost menus were developed for the health of both domestic animals and humans, and for productivity monetary losses. The incidence and prevalence of the disease in all species were obtained from national and personal reports. The domestic animal and human costs of echinococcosis in Tunisia were estimated using age-stratified rates and losses, productivity losses (including those not formally employed) and Monte Carlo sampling to represent the uncertainty inherent in some epidemiological and economic values. Echinococcosis in Tunisia causes significant direct and indirect losses in both humans and animals of approximately US dollars 10-19 million annually. These estimates are based on numerous methodological improvements over previous studies and are of considerable consequence relative to Tunisia's US dollars 21.2 billion gross domestic product. A cost-benefit analysis of control programmes using the methodological advances presented here and regional comparison to other endemic diseases is warranted. These may provide information to assist policy decision-makers in prioritizing the allocation of scarce resources.
authors.affiliation: Wellcome Trust Centre for the Epidemiology of Infectious Diseases, University of Oxford, Oxford, UK. meghan_majorowski@mckinsey.com
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Majorowski
authors.forename: Hélène
authors.initials: H
authors.lastname: Carabin
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kilani
authors.forename: Afif
authors.initials: A
authors.lastname: Bensalah
mesh_terms: D000818:Animals; D002417:Cattle; D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000379:methods; D003663:Decision Trees; D004443:Echinococcosis / Q000191:economics* / Q000453:epidemiology / Q000662:veterinary*; D048209:Echinococcus granulosus; D019353:Endemic Diseases / Q000191:economics* / Q000706:statistics & numerical data / Q000662:veterinary*; D018397:Equidae; D005260:Female; D006041:Goats; D006801:Humans; D015994:Incidence; D008297:Male; D018803:Models, Economic; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012756:Sheep; D014416:Tunisia / Q000453:epidemiology; D015047:Zoonoses / Q000453:epidemiology