title: The burden of Lyme borreliosis expressed in disability-adjusted life years.
abstract: BACKGROUND
  Lyme borreliosis (LB) is the most commonly reported tick-borne infection in Europe and North America. In the last 15 years a 3-fold increase was observed in general practitioner consultations for LB in the Netherlands. To support prioritization of prevention and control efforts for LB, we estimated its burden expressed in Disability-Adjusted Life Years (DALYs).
  
  
  METHODS
  We used available incidence estimates for three LB outcomes: (i) erythema migrans (EM), (ii) disseminated LB and (iii) Lyme-related persisting symptoms. To generate DALYs, disability weights and duration per outcome were derived using a patient questionnaire including health-related quality of life as measured by the EQ-5D.
  
  
  RESULTS
  We estimated the total LB burden for the Netherlands in 2010 at 10.55 DALYs per 100,000 population (95% CI: 8.80-12.43); i.e. 0.60 DALYs for EM, 0.86 DALYs for disseminated LB and 9.09 DALYs for Lyme-related persisting symptoms. Per patient this was 0.005 DALYs for EM, 0.113 for disseminated LB and 1.661 DALYs for a patient with Lyme-related persisting symptoms. In a sensitivity analysis the total LB burden ranged from 7.58 to 16.93 DALYs per 100,000 population.
  
  
  CONCLUSIONS
  LB causes a substantial disease burden in the Netherlands. The vast majority of this burden is caused by patients with Lyme-related persisting symptoms. EM and disseminated Lyme have a more modest impact. Further research should focus on the mechanisms that trigger development of these persisting symptoms that patients and their physicians attribute to LB.
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands kees.van.den.wijngaard@rivm.nl.
authors.forename: Cees C
authors.initials: CC
authors.lastname: van den Wijngaard
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Agnetha
authors.initials: A
authors.lastname: Hofhuis
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Margriet G
authors.initials: MG
authors.lastname: Harms
authors.affiliation: 2 Erasmus MC, Department of Public Health, Rotterdam, The Netherlands.
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Haagsma
authors.affiliation: 3 National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Wong
authors.affiliation: 4 National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Care, Bilthoven, The Netherlands 5 Julius Centre for Health Sciences and Primary Care, University Medical Hospital Utrecht, Utrecht, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands 6 Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
authors.forename: Arie H
authors.initials: AH
authors.lastname: Havelaar
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Lugnér
authors.affiliation: 4 National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Care, Bilthoven, The Netherlands.
authors.forename: Anita W M
authors.initials: AW
authors.lastname: Suijkerbuijk
authors.affiliation: 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D017281:Cost of Illness; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008193:Lyme Disease / Q000503:physiopathology*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013997:Time Factors