Evaluation of direct costs associated with alveolar and cystic echinococcosis in Austria

Background: Cystic echinococcosis (CE) is a globally occurring zoonosis, whereas alveolar echinococcosis (AE) is endemic only in certain parts of the Northern Hemisphere. The socioeconomic impact of human echinococcosis has been shown to be considerable in highly endemic regions. However, detailed data on direct healthcare-related costs associated with CE and AE are scarce for high income countries. The aim of this study was to evaluate direct costs of human disease caused by CE and AE in Austria. Methods: Clinical data from a registry maintained at a national reference center for echinococcosis at the Medical University of Vienna were obtained for the years 2012–2014. These data were used in conjunction with epidemiological data from Austria’s national disease reporting system and diagnostic reference laboratory for echinococcosis to assess nationwide costs attributable to CE and AE. Results: In Austria, total modelled direct costs were 486,598€ (95%CI 341,825€ – 631,372€) per year for CE, and 683,824€ (95%CI 469,161€ - 898,486€) for AE. Median costs per patient with AE from diagnosis until the end of a 10-year follow-up period were 30,832€ (25th– 75th percentile: 23,197€ - 31,220€) and 62,777€ (25th– 75th percentile: 60,806€ - 67,867€) for inoperable and operable patients, respectively. Median costs per patients with CE from diagnosis until end of follow-up after 10 years were 16,253€ (25th– 75th percentile: 8,555€ - 24,832€) and 1,786€ (25th– 75th percentile: 736€ - 2,146€) for patients with active and inactive cyst stages, respectively. The first year after inclusion was the most cost-intense year in the observed period, with hospitalizations and albendazole therapy the main contributors to direct costs. Conclusions: This study provides detailed information on direct healthcare-related costs associated with CE and AE in Austria, which may reflect trends for other high-income countries. Surgery and albendazole therapy, due to surprisingly high drug prices, were identified as important cost-drivers. These data will be important for cost-effectiveness analyses of possible prevention programs. Author summary: Cystic and alveolar echinococcosis, caused by E. granulosus and E. multilocularis, both occur in humans in Austria. Lesions may develop at any site, with the liver being most frequently affected. Morbidity–especially for alveolar echinococcosis–can be significant and treatment may include major surgery or long-term suppressive medical therapy. The present study was performed to investigate direct healthcare-related costs of cystic and alveolar echinococcosis in Austria based on the data from a clinical registry maintained at the reference center for echinococcosis, the reference laboratory for echinococcosis and data from the national disease reporting system. Annual incidences of AE and CE were estimated at λ = 12 and λ = 40 newly diagnosed cases per year, respectively. Estimated costs due to cystic echinococcosis were 486,598€ (95%CI 341,825€ – 631,372€) per year, and 683,824€ (95%CI 469,161€ - 898,486€) for AE. Major cost drivers were surgical interventions with hospitalizations and drug costs. These data will provide a basis for cost-effectiveness analyses of prevention programs, and highlight possible targets for cost reduction strategies.