The Global Economic and Health Burden of Human Hookworm Infection

Background: Even though human hookworm infection is highly endemic in many countries throughout the world, its global economic and health impact is not well known. Without a better understanding of hookworm’s economic burden worldwide, it is difficult for decision makers such as funders, policy makers, disease control officials, and intervention manufacturers to determine how much time, energy, and resources to invest in hookworm control. Methodology/Principle Findings: We developed a computational simulation model to estimate the economic and health burden of hookworm infection in every country, WHO region, and globally, in 2016 from the societal perspective. Globally, hookworm infection resulted in a total 2,126,280 DALYs using 2004 disability weight estimates and 4,087,803 DALYs using 2010 disability weight estimates (excluding cognitive impairment outcomes). Including cognitive impairment did not significantly increase DALYs worldwide. Total productivity losses varied with the probability of anemia and calculation method used, ranging from $7.5 billion to $138.9 billion annually using gross national income per capita as a proxy for annual wages and ranging from $2.5 billion to $43.9 billion using minimum wage as a proxy for annual wages. Conclusion: Even though hookworm is classified as a neglected tropical disease, its economic and health burden exceeded published estimates for a number of diseases that have received comparatively more attention than hookworm such as rotavirus. Additionally, certain large countries that are transitioning to higher income countries such as Brazil and China, still face considerable hookworm burden. Author Summary: Our work quantifies the economic and health burden associated with hookworm infection by country, WHO region, and worldwide. We also evaluated the burden by age, various costing methodologies, and ran an extensive sensitivity analysis on key and debated parameters to determine the robustness of our model’s resulting estimates. We report the DALYs associated with hookworm infections with consequent health outcomes in 2016 and show the impact that varying disability weights and likelihoods of anemia have on the estimates. Additionally, our study identified potential targets for future studies and data collection. Our results provide important information for decision makers. Without a better understanding of the economic and health burden of hookworm worldwide and in different countries, it is difficult for decision makers such as funders, policy makers, disease control officials, and intervention manufacturers to determine how much time, energy, and resources to invest in hookworm control. Our results can also help decision makers know where hookworm should fall on their priority lists and allocate limited resources.