The socio-economic burden of cystic echinococcosis in Morocco: A combination of estimation method

Abstract

Cystic echinococcosis (CE) is a major zoonosis in Morocco despite the launch of a national control programme in 2005. As its economic consequences have not been studied yet in Morocco, this study estimated CE impact in terms of monetary losses, disability-adjusted life years (DALY), and DALY for zoonotic diseases (zDALY) in the entire country and in specific regions for the 2011 to 2014 period. The direct monetary losses were related to organ seizure from infected animal in slaughterhouses, and to healthcare expenses as well as lost wages for infected humans. Animal production losses concerned milk yield, fertility, carcass weight, and wool production. Losses due to human infection were also composed of disability and productivity losses at work. Monte Carlo simulations were used to estimate monetary losses and zDALY values. Nationwide, the estimated DALY was 0.5 years per 100,000 persons per year, and the zDALY was 55 years per 100,000 persons per year. Total yearly losses were estimated at 73 million USD (54-92 million USD). However, losses differed significantly among regions. Most of the economic losses consisted of unperceived consequences, i.e. decreased animal production and reduced productivity of asymptomatic individuals. Future studies should determine the socioeconomic and epidemiological factors underlying the differences in economic losses among regions to develop better adapted control programmes.

Fig 1. Regions of Morocco according to ONSSA.

CODA: Chaouia Ouardigha Doukkala Abda; GC: Grand Casablanca; LBSGE: Laayoune Boujdour Sakia El Hamra Guelmim Essmara; MT: Meknes Tafilalet; MTATA: Marrakech Tensift Al Haouz Tadla Azilal; Or: Oriental; RSZCBH: Rabat Sale Zemmour Zaer Chrarda Bni Hssen; SM: Souss Massa Draâ; THTFB: Taza Alhoceima Taounate Fes Boulemane; TT: Tanger Tetouan (Adapted from Wikimedia commons: https://commons.wikimedia.org/wiki/File:Morocco_Regions_97-11_numbered.svg).

Fig 2. Khénifra province (in green).

(Source: Wikimedia commons: https://commons.wikimedia.org/w/index.php?search=province+de+khenifra&title=Special%3ASearch&go=Continuer&uselang=fr&ns0=1&ns6=1&ns12=1&ns14=1&ns100=1&ns106=1#/media/File:Khenifra_in_Morocco.png).

Fig 3. Schematic description of how the loss of workdays was estimated in function of the patient age group and environment features.

Fig 4. Total economic losses (whole country) caused by CE in humans and animals for the 2011–2014 period.

Monte Carlo simulations.

Fig 5

Economic losses (in million USD) for the whole country due to CE in humans (top) and livestock (bottom) for the 2011–2014 period. Monte Carlo simulations.

Fig 6. CE-linked economic losses according to the loss type (million USD) for the whole country, logarithmic scale.

Monte Carlo simulations. Losses related to surgery include medical and non-medical costs (transport, food, accompanying person…).

Fig 7. Economic losses (Y-axis = million USD) caused by CE by region estimated with Monte Carlo simulations.

.CODA: Chaouia Ouardigha Doukkala Abda; GC: Grand Casablanca; LBSGE: Laayoune Boujdour Sakia El Hamra Guelmim Essmara; MT: Meknes Tafilalet; MTATA: Marrakech Tensift Al Haouz Tadla Azilal; Or: Oriental; RSZCB: Rabat Sale Zemmour Zaer Chrarda Bni Hssen; SM: Souss Massa Draâ; THTFB: Taza Alhoceima Taounate Fes Boulemane; TT: Tanger Tetouan.

Fig 8

Economic losses (million USD) due to CE in humans (top) and animals (bottom) in the Laayoune Boujdour Sakia El Hamra Guelmim Essmara (LSBGE) region. Monte Carlo simulation.

Fig 9. Estimated number of zDALYs per year due to CE in Morocco.

The zDALY was calculated by adding the animal loss equivalents (ALE in blue) to the disability-adjusted life years (DALY in orange) value.

Fig 10. Animal loss equivalents (ALE) and human losses converted to lost years of work.