Lyme borreliosis in Belgium: a cost-of-illness analysis

Abstract

Background Lyme borreliosis (LB) is the most common tick-borne disease in Europe and North America, yet its economic burden remains largely unknown. This study aimed to estimate the economic cost associated with the different clinical manifestations of LB in Belgium. Methods An incidence approach and societal perspective were used to estimate the total cost-of-illness for LB in Belgium. Costs were calculated for patients with erythema migrans (EM) or disseminated/late LB, including patients who developed post-treatment Lyme disease syndrome (PTLDS). Direct medical, direct non-medical (transportation & paid help) and indirect non-medical costs (productivity losses) were included in the analysis. Ambulatory cost data were collected through a prospective cohort study from June 2016 to March 2020, in which patients with LB were followed up 6 to 12 months after diagnosis. Hospitalization costs were retrieved from the Minimal Clinical Data registry, a mandatory registry for all Belgian hospitals, linked to the Minimal Financial Data registry. Costs were expressed in 2019 euros. Results The total annual cost associated with clinical manifestations of LB in Belgium was estimated at €5.59 million (95% UI 3.82–7.98). Of these, €3.44 million (95% UI 2.05–5.48) or 62% was related to disseminated/late LB diagnoses and €2.15 million (95% UI 1.30–3.26) to EM. In general, direct medical costs and productivity losses accounted for 49.8% and 46.4% of the total costs, respectively, while direct non-medical costs accounted for only 3.8%. The estimated mean costs were €193 per EM patient and €5,148 per disseminated/late LB patient. While patients with PTLDS seemed to have somewhat higher costs compared to patients without PTLDS, the number of patients was too small to have representative estimates. Conclusions We estimate the total annual direct medical costs, direct non-medical and indirect non-medical costs associated with LB to exceed €5.5 million per year, almost evenly distributed between EM (40%) and disseminated/late LB (60%). EM costs 26 times less per patient but occurs also 16 times more frequently than disseminated/late LB. The cost burden remains limited by comparison to other infectious diseases due to the relative lower incidence.

Cost of illness in patients with post-treatment Lyme disease syndrome in Belgium

“…Our estimation is considerably higher than the recently calculated societal cost of €5.6M in the first year after diagnosis in Belgium. 24 This difference can largely be explained by differences in the patient population (Geebelen et al included only a few patients with PTLDS), the population size estimation (Geebelen et al’s 24 estimation is incidence-based whereas our calculation is prevalence-based) and the methodological approach.…”

“… 22 A recently published Belgian study estimated €193 per patient with EM and €5148 per patient with disseminated LB. 24 …”

“…The same Belgian study included few patients with PTLSD and called for more research in this patient population. 24 Hence, data on direct and indirect costs attributable to persistent symptoms are still lacking for Belgium. Information is also limited on possible non-reimbursable healthcare utilization, as such data are not included in administrative databases.…”

Healthcare costs and outcomes associated with laboratory-confirmed Lyme disease in Ontario, Canada: A population-based cohort study

“…Lastly, the attributable economic burden of LD may be underreported due to dataset limitations. While the non-medical costs of LD have been recently studied in Belgium and the United States [ 28 , 29 ], this analysis on economic burden only focuses on the healthcare costs and does not capture societal costs that may arise due to long-term sequelae and PTLDS such as caregiver costs, wellbeing costs, out-of-pocket costs, and productivity loss.…”

Bacterial Vector-Borne Zoonotic Diseases and One Health Approach. A Review

“…disease that can affect many organs and have various clinical manifestations in animals [8,24]. LB is the most common vector-borne disease in the Northern Hemisphere, transmitted to humans by the bite of Ixodes ticks [10,23,29]. Many mammalian and avian species become infected but do not develop overt clinical signs.…”