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Economic Impact of E. Coli O111 Outbreak in 1995 in Australia

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Economic Impact of E. Coli O111 Outbreak in 1995 in Australia American Journal of Applied Sciences 1 (4): 302-308, 2004 ISSN 1546-9239 © Science Publications, 2004 Economic Impact of E. Coli O111 Outbreak in 1995 in Australia 1Shahjahan Ali Khandaker and 2Mohammad Alauddin 1Health Economics Unit, Ministry of Health and Family Welfare Government of Bangladesh, Dhaka, Bangladesh 2School of Economics, The University of Queensland, Brisbane, QLD. 4072, Australia Abstract: Increased incidence of food-borne illnesses is a matter of significant concern for the community and the government alike. An outbreak of E. coli O111 that occurred in Australia in 1995 affected 200 people of whom 22 developed HUS while one person died. This study analyses the economic costs of the outbreak. The total cost of the outbreak is estimated to be A$5. 61 million. Productivity loss represented the highest percentage of outbreak costs (66%) due to death, disability and chronic illness. The direct medical costs contributed 33%. The estimated loss could be even higher if all costs could be quantified. Nevertheless, the findings provide an idea of the policy maker regarding the extent and nature of the damage that could result from an outbreak. The severity of the damage warrants allocation of necessary resources to prevent such occurrences. Key words: E. coli Outbreak, Food-Borne Illness, Economic Costs, Productivity Loss INTRODUCTION Communicable Disease Control Unit of the Health Commission (SACDCU) issued a press release noting There has been an increasing trend of foodborne the link of this outbreak with a sausage prepared from illnesses and outbreaks throughout the world. These are beef[9]. a matter of concern for the community and the A locally produced fermented sausage (mettwurst) government alike. Foodborne illnesses entail costs not was incriminated by epidemiological and only to the ill person and the immediate family, but also microbiological investigation. The outbreak occurred as are a cause of major economic cost to the food industry a complication of infection associated with the in producing and marketing food, reducing consumer consumption of the uncooked, semi-dry, fermented confidence and to public health regulations and sausage [10,11] . enforcement that set ground rules for food production [1,2,3] The Women’s and Children’s Hospital, Institute of and preparation . Estimation of costs of foodborne Medical and Veterinary Science and The National illness is thus important for policy decision and Centre for Epidemiology and Population Health at the allocation of necessary resources to undertake a suitable Australian National University reported the outbreak on control program. Several studies on economic impact the basis of their investigation results. E. coli O111 was have been undertaken in the UK [2,4] , the USA [5,6] and identified from the outbreak and from sausages [10,11] . Canada [7]. Australia has experienced outbreaks of foodborne MATERIALS AND METHODS diseases since 1980. The major outbreaks reported are Norwalk virus outbreak in 1991, the South Australian E. coli O111 outbreak in 1995, Salmonella outbreak The Cost of Illness (COI) approach is used to 1996 in Victoria and Queensland and Hepatitis A estimate direct medical costs and productivity loss oysters outbreak 1997 in New South Wales [8]. Although associated with the outbreak due to E. coli O111 a preliminary estimation of costs of total foodborne infection in 1995. The method simply conveys the illnesses was made [8], there does not seem to have been aggregate burden of illness on the society. Both direct any comprehensive economic study in this area. This and indirect costs are estimated from the outbreak. study seeks to fill this gap by estimating socioeconomic Physician visit, hospital costs, disease investigation, costs of the E. coli O111outbreak that occurred in dialysis and kidney transplant are considered as direct Australia in 1995. costs and loss of productivity from missing work for both patients and parents/care and travel costs are The outbreak-a brief overview: An outbreak of measured as an indirect cost. The estimated costs Escherichia coli O111 occurred in South Australia in depend on the severity of illness as well as the age of January to February 1995. About 200 people were the patient. The economic factors, which may influence affected by Haemorrhagic Colitis (HC), 23 children the costs of illness, are identified. The calculations of developed Haemolytic Uraemia Syndrome (HUS) with the estimates are based on some assumptions that are one death occurring. The South Australian made from relevant studies in the literature. 302 American J. Appl. Sci., 1 (4), 302-308, 2004 Age and sex distribution [2]: Reported that almost 50% of the cases were under 5 years and 70% under 16 years [9]. Reported the median age of 23 patients was 4 years. Following this, assumptions are made (decision tree) for this study and results presented in Table 2a. Direct medical costs: Acute illness medical costs include both hospital and non-hospital costs, cabin charges, physician fees, fluid therapy, medicines and drugs, pathological tests, blood transfusion and other related treatment except surgical intervention [13] . The medical costs of patients at hospital stay are computed from the data provided by Australian Refined- Diagnostic Related Group (AR-DRG) version 4.2. [13] . The following direct costs are estimated from the Fig. 1: Decision Tree for E. Coli Outbreak in 1995 in outbreak. Australia Non-hospitalization costs: It is assumed that 50% Estimation of illness: To estimate the number of cases (100) of the patients affected with mild and moderate of the outbreak a decision tree was constructed based infection visited a physician. Following [14] , it is on the previous references and the available assumed that these patients required on average two information about the outbreak (Fig. 1). The number of physician consultations, one simple diagnostic stool test patients in different severity groups is estimated from and some medicine including oral saline. The the decision tree. consultation fee of physician is estimated at A$22 from the data of Medibank reimbursement rate (Personal communication with the local Medibank Private Office, Total number of cases: It was reported that 200 cases Queensland). The cost for stool test is estimated at developed bloody diarrhoea, abdominal cramp and [12] A$35. 00 (Personal communication with Laboratory vomiting from the outbreak . This study uses this as Section, Cleveland Hospital, Queensland). an estimated total number of cases of the outbreak. Hospitalization costs for Acute HC: Patients with Mild case: From the decision tree it is assumed that Hemorrhagic Colitis (HC) were hospitalized for bloody 100 affected people visited a physician and did not diarrhea, dehydration and severe abdominal cramps. It require hospitalization due to a lesser degree of severity is reported that a gastroenteritis patient requires at most of illness. eleven days of hospitalization [15] . Therefore, this study assumes ten day hospital stay to estimate the costs of [13] Acute case: It is assumed that all acute cases were acute illness. Using the formula of AR-DRG , the hospital costs of a patient are calculated at A$1, 359 for required to be hospitalized since the outbreak. [16] Seventyseven Haemolytic Colitis (HC) and 23 10 days . Haemolytic Uraemic Syndrome (HUS) patients were Hospitalization costs for Acute HUS: Of the treated for acute illness. estimated 22 HUS patients, sixteen (70%) required dialysis in acute stage. The average length of hospital Chronic case: It was reported that 4 patients out of the [9,12] stay by the acute HUS patient was estimated at 26 days 23 Haemolytic Uraemic Syndrome (HUS) patients [17] . Following [17] , this study uses the assumption of an suffered chronic renal failure. average 26 day hospital stay. The cost for the acute HUS patient is estimated at A $7,464 from AR-DRG Death: Death of one child was reported from the acute [13] [9] data . haemolytic uraemic syndrome . Chronic illness medical costs: It is reported that a The number of hospitalized cases: As there is no proportion of HUS patients suffered chronic kidney information about the proportion of patients admitted to failure, requiring dialysis, kidney transplants and drug hospital from the acute phase of the outbreak, this study therapy. Estimated medical costs of chronic illness are assumes that all acute patients were required to be calculated by summing the costs of these three items. hospitalized. Therefore, 100 patients (50%) were From available data [9], this study assumes that 18 % (4 hospitalized from the outbreak. It is also assumed that patients) suffered renal failure and TTP (Thrombotic 50% of the cases were recorded in hospital and the thromcytopenic pupura). Previous studies [5,23] reported physician recorded the remaining 50% of the cases. that at least 6 months haemo-dialysis were required for 303 American J. Appl. Sci., 1 (4), 302-308, 2004 a chronic HUS patient before undertaking kidney required for recuperation. Adjusted with a weekend transplant or the start of home dialysis. This study caretaker or parent missed 56 days. The same assumed that one patient went to kidney transplant from assumptions as hospitalized HC patients are made to the second year, one of the third year and one started estimate loss from hospitalized HUS patients. with home dialysis from the third year. One patient continued to suffer from TTP. The annual hospital Loss from premature death: One 4 year child died dialysis costs for a patient is A$42, 348 and home from acute HUS [9]. Productivity loss from this dialysis is A$29, 571 [13] . Costs for 10 months of the premature death is measured based on the method in [19] . initial year are estimated at A$37, 790. The costs for a The loss is measured from age 4 years old to expect kidney transplant are estimated at A$21, 594 with an average life 77 years old [20] . The study uses A$66, 699 average length 11 days of hospital stay [13] .
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