Estimating the population health burden of Lyme disease in Ontario, Canada: a microsimulation modelling approach
Autor: | Stephen Mac, Beate Sander, Samir N. Patel, Eleanor Pullenayegum, Gerald A Evans |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Pediatrics Psychological intervention Population health Cohort Studies Young Adult Lyme disease Cost of Illness Quality of life Humans Medicine Public Health Surveillance Disease burden Ontario Lyme Disease business.industry Research Public health General Medicine Middle Aged Models Theoretical medicine.disease Confidence interval Cross-Sectional Studies Cohort Quality of Life Female Quality-Adjusted Life Years business |
Zdroj: | CMAJ Open |
ISSN: | 2291-0026 |
Popis: | Background If untreated, Lyme disease can lead to long-term sequelae and post-treatment Lyme disease syndrome (PTLDS), resulting in reduced health-related quality of life. The objective of this study was to develop a microsimulation model to estimate the population-level health burden of Lyme disease in Ontario, Canada. Methods We developed a Lyme disease history model using microsimulation, simulating 100 000 people (mean age 37.6 yr, 51% female) from 2017 in Ontario over a lifetime risk of infection and time horizon. We extracted the sensitivity and specificity of the 2-tier testing recommended by the Canadian Public Health Laboratory Network, probabilities and health state utility values from the published literature and health administrative data. Our reported outcomes from our stochastic analysis include diagnosed cases of Lyme disease (stratified by stage), undiagnosed infections, sequelae, individuals with PTLDS and quality-adjusted life-years (QALYs) lost. Results Our model estimated 333 (95% confidence interval [CI] 329-337) infections over the lifetime of 100 000 simulated people (mean age 37.6 yr, 51% female), with 92% (95% CI 91%-93%) of infections diagnosed. Of those 308 people with Lyme Disease diagnoses, 67 (95% CI 65-69) developed sequelae (e.g., arthritic, cardiac, neurologic sequelae), and 34 (95% CI 33-35) developed PTLDS. Lyme disease resulted in a loss of 84.5 QALYs (95% CI 82.9-86.2) over the lifetime of the simulated cohort. Sensitivity and scenario analysis showed that increasing incidence rates of Lyme disease, potential underreporting, duration of PTLDS and quality of life (health state utility) associated with PTLDS had the greatest impact on health burden. Interpretation Lyme disease contributes considerable health burden in terms of QALYs lost. Our analysis provides evidence to understand the disease burden and lays the foundation to assess the cost-effectiveness of pharmaceutical and nonpharmaceutical interventions. |
Databáze: | OpenAIRE |
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