Risk ranking of foodborne parasites: State of the art

Abstract

In a time of increasing threats and decreasing financial resources, monitoring and controlling all possible foodborne hazards at the same time and to the same extent has become more challenging than ever. Therefore, attention is increasingly being paid to the so-called "risk ranking" methods that enable decision makers to focus on the most important foodborne hazards - even when time is limited and knowledge incomplete. In this review paper, we provide an overview of the most common quantitative methods and metrics used for ranking the risks associated with foodborne parasites and present the state of the art on risk ranking exercises for foodborne parasites. A number of risk ranking metrics and methods are available, ranging from simple approaches that can be used to assess the health or economic impact of a foodborne parasitic disease, to more complicated but more comprehensive multi-criteria assessments. For health impact assessment, measures of population health such as disease occurrence and number of deaths; Disability-Adjusted Life Years (DALYs) measuring the healthy life years lost; and Quality-Adjusted Life Years (QALYs) measuring the number of life years lived in optimal health, are described. For economic impact assessment, applied approaches that measure the cost-of-illness from a societal perspective and stated preference methods are outlined. Finally, Multi-Criteria Decision Analysis (MCDA), which can be used to integrate multiple metrics and criteria into a single ranking, is described. These risk ranking methods for foodborne parasites are increasingly performed to aid priority setting at global, regional, and national levels. As different stakeholders have their own prioritization objectives and beliefs, the outcome of such exercises is necessarily context-dependent. Therefore, when designing a risk ranking exercise for foodborne parasites, it is important to choose the metrics and methods, as well as what to rank, in the light of the predefined context of the question being addressed and the target audience.

Keywords: Cost-of-illness; DALY, Disability-Adjusted Life Year; Disability-adjusted life years; FAO, Food and Agriculture Organization of the United Nations; Foodborne parasites; GBD, Global Burden of Disease; MCDA, Multi-Criteria Decision Analysis; Multi-criteria decision analysis; Priority setting; QALY, Quality-Adjusted Life Year; SMPH, Summary Measure of Population Health; WHO, World Health Organization; WTA, Willingness-to-accept; WTP, Willingness-to-pay; YLD, Year Lived with Disability; YLL, Year of Life Lost.

Fig. 1

Disease model for congenital toxoplasmosis (CT), adapted from Nissen et al. (2017). Green boxes accrue years lived with disability, red boxes accrue years of life lost. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Foodborne Disability-Adjusted Life Years (DALYs) per 100,000 population, per World Health Organization sub-region (Torgerson et al., 2015, Kirk et al., 2015). AFR: African Region, AMR: Region of the Americas, EMR: Eastern Mediterranean Region, EUR: European Region, SEAR: South-East Asia Region, WPR; Western Pacific Region; Stratum A: very low child and adult mortality, Stratum B: low child mortality and very low adult mortality, Stratum C: low child mortality and high adult mortality, Stratum D: high child and adult mortality, Stratum E: high child mortality and very high adult mortality.

Fig. 3

Global ranking of foodborne parasites using multi-criteria decision analysis (FAO/WHO (Food and Agriculture Organization of the United Nations and World Health Organization), 2014). The normalized overall scores are weighted sums of normalized criteria scores and weights elicited from expert meeting participants.