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!


The societal impact of bovine tuberculosis in select Asian countries

Recommandé

Recommandé

Contenu connexe

Similaire à The societal impact of bovine tuberculosis in select Asian countries

Similaire à The societal impact of bovine tuberculosis in select Asian countries (20)

Plus de Global Risk Forum GRFDavos

Plus de Global Risk Forum GRFDavos (20)

Dernier

Dernier (20)

The societal impact of bovine tuberculosis in select Asian countries

Notes de l'éditeur