Economic Impact


According to an actuarial study on Lyme costs, “37% of the financial costs of this disease is incurred before the correct diagnosis is made.”  

According to a 1998 CDC journal study, early Lyme costs averaged $161 per patient and neurologic longstanding Lyme disease averaged $61,243 per year, per patient.


Costs of Lyme Disease 

Studies 1992 - 2018


Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease.  Berende A, Nieuwenhuis L, Ter Hofstede HJM, Vos FJ, Vogelaar ML, Tromp M, van Middendorp H, Donders ART, Evers AWM, Kullberg BJ, Adang EMM.  PLoS One. 2018 Apr 2;13(4):e0195260. doi: 10.1371/journal.pone.0195260. eCollection 2018. PMID:  29608590  https://www.ncbi.nlm.nih.gov/pubmed/29608590

 

The Financial Implications of a Well-Hidden and Ignored Chronic Lyme Disease Pandemic.  Davidsson M. Healthcare (Basel). 2018 Feb 13;6(1). pii: E16. doi: 10.3390/healthcare6010016.  PMID:  29438352 https://www.ncbi.nlm.nih.gov/pubmed/29438352

 

A systematic review and meta-analysis for the adverse effects, immunogenicity and efficacy of Lyme disease vaccines: Guiding novel vaccine development.  Badawi A, Shering M, Rahman S, Lindsay LR. Can J Public Health. 2017 Apr 20;108(1):e62-e70. doi: 10.17269/cjph.108.5728. Review. PMID:  28425901  https://www.ncbi.nlm.nih.gov/pubmed/28425901

 

The cost of Lyme borreliosis. van den Wijngaard CC, Hofhuis A, Wong A, Harms MG, de Wit GA, Lugnér AK, Suijkerbuijk AWM, Mangen MJ, van Pelt W.  Eur J Public Health. 2017 Jun 1;27(3):538-547. doi: 10.1093/eurpub/ckw269. PMID: 28444236  https://www.ncbi.nlm.nih.gov/pubmed/28444236

  

The HUMTICK study: protocol for a prospective cohort study on post-treatment Lymedisease syndrome and the disease and cost burden of Lyme borreliosis in Belgium.  Geebelen L, Lernout T, Kabamba-Mukadi B, Saegeman V, Sprong H, Van Gucht S, Beutels P, Speybroeck N, Tersago K. Arch Public Health. 2017 Aug 7;75:42. doi: 10.1186/s13690-017-0202-z. eCollection 2017. PMID:  28794875  https://www.ncbi.nlm.nih.gov/pubmed/28794875

 

Hospitalized Children With Encephalitis in the United States: A Pediatric Health Information System Database Study.  Bagdure D, Custer JW, Rao S, Messacar K, Dominguez S, Beam BW, Bhutta A. Pediatr Neurol. 2016 Aug;61:58-62. doi: 10.1016/j.pediatrneurol.2016.04.014. Epub 2016 May 6.  PMID:  27353693   https://www.ncbi.nlm.nih.gov/pubmed/27353693

 

Testing practices and volume of non-Lyme tickborne diseases in the United States. Connally NP, Hinckley AF, Feldman KA, Kemperman M, Neitzel D, Wee SB, White JL, Mead PS, Meek JI.  Ticks Tick Borne Dis. 2016 Feb;7(1):193-198. doi: 10.1016/j.ttbdis.2015.10.005. Epub 2015 Oct 30.   https://www.ncbi.nlm.nih.gov/pubmed/26565931

 

Health care costs, utilization and patterns of care following Lyme disease.  Adrion ER, Aucott J, Lemke KW, Weiner JP. PLoS One. 2015 Feb 4;10(2):e0116767. doi: 10.1371/journal.pone.0116767. eCollection 2015.  PMID:  25650808    https://www.ncbi.nlm.nih.gov/pubmed/25650808

 

The burden of Lyme borreliosis expressed in disability-adjusted life years.  van den Wijngaard CC, Hofhuis A, Harms MG, Haagsma JA, Wong A, de Wit GA, Havelaar AH, Lugnér AK, Suijkerbuijk AW, van Pelt W.  Eur J Public Health. 2015 Dec;25(6):1071-8. doi: 10.1093/eurpub/ckv091. Epub 2015 Jun 16  PMID:  26082446    https://www.ncbi.nlm.nih.gov/pubmed/26082446

 

Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.  Lohr B, Müller I, Mai M, Norris DE, Schöffski O, Hunfeld KP.  Ticks Tick Borne Dis. 2015 Feb;6(1):56-62. doi: 10.1016/j.ttbdis.2014.09.004. Epub 2014 Oct 19. PMID:  25448420  https://www.ncbi.nlm.nih.gov/pubmed/25448420

 

Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics.  Šmit R, Postma MJ.  Expert Rev Vaccines. 2015;14(12):1549-61. doi: 10.1586/14760584.2015.1091313. Epub 2015 Sep 28. Review. PMID:26414102  https://www.ncbi.nlm.nih.gov/pubmed/26414102

 

Vaccines for tick-borne diseases and cost-effectiveness of vaccination: a public health challenge to reduce the diseases' burden.  Šmit R, Postma MJ. Expert Rev Vaccines. 2016;15(1):5-7. doi: 10.1586/14760584.2016.1111142. Epub 2015 Nov 11.  PMID: 26559456   https://www.ncbi.nlm.nih.gov/pubmed/26559456

 

Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)--design of a randomized controlled trial of prolonged antibiotic treatment in patients with persistent symptoms attributed to Lyme borreliosis.  Berende A, ter Hofstede HJ, Donders AR, van Middendorp H, Kessels RP, Adang EM, Vos FJ, Evers AW, Kullberg BJ.  BMC Infect Dis. 2014 Oct 16;14:543. doi: 10.1186/s12879-014-0543-y.    https://www.ncbi.nlm.nih.gov/pubmed/25318999

 

Lyme disease testing by large commercial laboratories in the United States. Hinckley AF, Connally NP, Meek JI, Johnson BJ, Kemperman MM, Feldman KA, White JL, Mead PS. Clin Infect Dis. 2014 Sep 1;59(5):676-81. doi: 10.1093/cid/ciu397. Epub 2014 May 30. PMID: 24879782  https://www.ncbi.nlm.nih.gov/pubmed

 

Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study. Lantos PM, Brinkerhoff RJ, Wormser GP, Clemen R. Vector Borne Zoonotic Dis. 2013 Dec;13(12):877-83. doi: 10.1089/vbz.2013.1365. Epub 2013 Oct 9. PMID:  24107201     https://www.ncbi.nlm.nih.gov/pubmed/24107201

 

Comparative cost-effectiveness of two-tiered testing strategies for serodiagnosis of lyme disease with noncutaneous manifestations.  Wormser GP, Levin A, Soman S, Adenikinju O, Longo MV, Branda JA. J Clin Microbiol. 2013 Dec;51(12):4045-9. doi: 10.1128/JCM.01853-13. Epub 2013 Sep 25.  PMID: 24068010   https://www.ncbi.nlm.nih.gov/pubmed/24068010

 

Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis.Müller I, Freitag MH, Poggensee G, Scharnetzky E, Straube E, Schoerner Ch, Hlobil H, Hagedorn HJ, Stanek G, Schubert-Unkmeir A, Norris DE, Gensichen J, Hunfeld KP. Clin Dev Immunol. 2012;2012:595427. doi: 10.1155/2012/595427. Epub 2011 Dec 27. PMID: 22242037   https://www.ncbi.nlm.nih.gov/pubmed/22242037

 

Healthcare access and burden of care for patients with Lyme disease: a large United States survey. Johnson L, Aylward A, Stricker RB. Health Policy. 2011 Sep;102(1):64-71. doi: 10.1016/j.healthpol.2011.05.007. Epub 2011 Jun 14.  PMID: 21676482    https://www.ncbi.nlm.nih.gov/pubmed/21676482

 

A safe and cost-effective approach to treating Lyme cardiac disease in an era of health care reform.  Kim J, Beldner SJ, Jadonath R, Altman EJ.  Pacing Clin Electrophysiol. 2011 Jun;34(6):666-9. doi: 10.1111/j.1540-8159.2011.03095.x. Epub 2011 Mar 31. No abstract available. PMID: 21453343  https://www.ncbi.nlm.nih.gov/pubmed/21453343

 

Neuroborreliosis--an epidemiological, clinical and healthcare cost study from an endemic area in the south-east of Sweden.Henningsson AJ, Malmvall BE, Ernerudh J, Matussek A, Forsberg P. Clin Microbiol Infect. 2010 Aug;16(8):1245-51. doi: 10.1111/j.1469-0691.2009.03059.x. Epub 2009 Sep 29. PMID: 19793326   https://www.ncbi.nlm.nih.gov/pubmed/19793326

 

Cost-effectiveness of peptide-antigen immunoassays for Lyme disease. Porwancher RB. J Infect Dis. 2004 May 15;189(10):1962; author reply 1962-4. No abstract available.  PMID: 15122535    https://www.ncbi.nlm.nih.gov/pubmed/15122535

 

Lyme disease--what is the cost for Scotland? Joss AW, Davidson MM, Ho-Yen DO, Ludbrook A. Public Health. 2003 Jul;117(4):264-73. PMID: 12966749    https://www.ncbi.nlm.nih.gov/pubmed/12966749

 

Cost-effectiveness analysis of the Lyme disease vaccine. Hsia EC, Chung JB, Schwartz JS, Albert DA.  Arthritis Rheum. 2002 Jun;46(6):1651-60. PMID: 12115198   https://www.ncbi.nlm.nih.gov/pubmed/12115198

 

Vaccination for Lyme disease: cost-effectiveness versus cost and value. Sigal LH. Arthritis Rheum. 2002 Jun;46(6):1439-42. Review. No abstract available. PMID: 12115172   https://www.ncbi.nlm.nih.gov/pubmed

 

The cost-effectiveness of vaccination against Lyme disease.  Shadick NA, Liang MH, Phillips CB, Fossel K, Kuntz KM. Arch Intern Med. 2001 Feb 26;161(4):554-61. PMID: 11252114   https://www.ncbi.nlm.nih.gov/pubmed/11252114

 

The cost-effectiveness of vaccinating against Lyme disease.  Prybylski D. Emerg Infect Dis. 1999 Sep-Oct;5(5):727-8. No abstract available.  PMID: 10511535  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627729/

 

Recommendations for the use of Lyme disease vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP) [No authors listed]  MMWR Recomm Rep. 1999 Jun 4;48(RR-7):1-17, 21-5. Erratum in: MMWR Morb Mortal Wkly Rep 1999 Sep 24;48(37):833. PMID: 10371254 https://www.cdc.gov/mmwr/preview/mmwrhtml/rr4807a1.htm

 

The cost effectiveness of vaccinating against Lyme disease.  Meltzer MI, Dennis DT, Orloski KA. Emerg Infect Dis. 1999 May-Jun;5(3):321-8.  PMID: 10341168 https://www.ncbi.nlm.nih.gov/pubmed/10341168

 

Tick bites and Lyme disease in an endemic setting: problematic use of serologic testing and prophylactic antibiotic therapy. Fix AD, Strickland GT, Grant J. JAMA. 1998 Jan 21;279(3):206-10.  PMID: 9438740  https://www.ncbi.nlm.nih.gov/pubmed/9438740

 

Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis.  Nichol G, Dennis DT, Steere AC, Lightfoot R, Wells G, Shea B, Tugwell P.  Ann Intern Med. 1998 Jan 1;128(1):37-48.  PMID: 9424980    https://www.ncbi.nlm.nih.gov/pubmed/9424980

 

cost-of-illness study of Lyme disease in the United States. Maes E, Lecomte P, Ray N. Clin Ther. 1998 Sep-Oct;20(5):993-1008; discussion 992. Erratum in: Clin Ther 1999 Feb;21(2):430.  PMID: 9829450  https://www.ncbi.nlm.nih.gov/pubmed/9829450

 

Antibiotic therapy for Lyme disease in Maryland.  Strickland GT, Caisley I, Woubeshet M, Israel E. Public Health Rep. 1994 Nov-Dec;109(6):745-9.  PMID: 7800782 https://www.ncbi.nlm.nih.gov/pubmed/7800782

 

Empiric parenteral antibiotic treatment of patients with fibromyalgia and fatigue and a positive serologic result for Lyme disease. A cost-effectiveness analysis. Lightfoot RW Jr, Luft BJ, Rahn DW, Steere AC, Sigal LH, Zoschke DC, Gardner P, Britton MC, Kaufman RL. Ann Intern Med. 1993 Sep 15;119(6):503-9. PMID: 8357117 https://www.ncbi.nlm.nih.gov/pubmed/8357117

 

[Cefuroximaxetil: Effective and Cost Effective, From Respiratory Tract Infections to Lyme Disease. Proceedings from the 18th International Congress of Chemotherapy. Stockholm, 27 June-2 July 1993]. [No authors listed] Fortschr Med Suppl. 1993;151:1-15. German. No abstract available.  PMID: 7905849 https://www.ncbi.nlm.nih.gov/pubmed/7905849

 

Prevention of Lyme disease after tick bites. A cost-effectiveness analysis. Magid D, Schwartz B, Craft J, Schwartz JS. N Engl J Med. 1992 Aug 20;327(8):534-41. PMID: 1298217  https://www.ncbi.nlm.nih.gov/pubmed/1298217

 


Abstracts

Emerg Infect Dis. 2006 Apr;12(4):653-60.

Economic impact of Lyme disease.

Zhang XMeltzer MIPeña CAHopkins ABWroth LFix AD.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. XZhang4@cdc.gov

Abstract

To assess the economic impact of Lyme disease (LD), the most common vectorborne inflammatory disease in the United States, cost data were collected in 5 counties of the Maryland Eastern Shore from 1997 to 2000. Patients were divided into 5 diagnosis groups, clinically defined early-stage LD, clinically defined late-stage LD, suspected LD, tick bite, and other related complaints. 

From 1997 to 2000, the mean per patient direct medical cost of early-stage LD decreased from $1,609 to $464 (p<0.05), and the mean per patient direct medical cost of late-stage LD decreased from $4,240 to $1,380 (p<0.05). 

The expected median of all costs (direct medical cost, indirect medical cost, nonmedical cost, and productivity loss), aggregated across all diagnosis groups of patients, was approximately $281 per patient. These findings will help assess the economics of current and future prevention and control efforts.


Clin Ther. 1998 Sep-Oct;20(5):993-1008; discussion 992.

A cost-of-illness study of Lyme disease in the United States.

Maes ELecomte PRay N.

The Lewin Group, Mechelen, Belgium.

Erratum in:

  • Clin Ther 1999 Feb;21(2):430.

Abstract

Lyme disease produces a diverse clinical picture that can include serious and potentially debilitating cardiac, neurologic, joint, and skin involvement. It is characterized in three stages--early localized (stage I), early disseminated (stage II), and late disseminated (stage III)--and medical management is highly dependent on the stage at which the patient presents and the physician's awareness of available treatment options. 

This study was conducted to establish the medical and economic burden of Lyme disease in the overall US population, which included determining its endemicity in high-risk states and counties, describing current treatment patterns, measuring direct and indirect costs, and defining the cost burden by age group (<18 years and > or =18 years of age). 

Medical, epidemiologic, and economic data were collected, and an algorithm was developed representing the natural course of Lyme disease and the progress of health states over time following medical intervention. Using an annual mean incidence of 4.73 cases of Lyme disease per 100,000 population in the decision analysis model yielded an expected national expenditure of $2.5 billion (1996 dollars) over 5 years for therapeutic interventions to prevent 55,626 cases of Lyme disease sequelae. 

This estimate included both direct medical and indirect costs. However, there is evidence of considerable variation in incidence within states. Our findings support development of vaccination strategies for specific target groups.

 PMID: 9829450 [PubMed - indexed for MEDLINE]


Ann Intern Med. 1998 Jan 1;128(1):37-48.

Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis.

Nichol GDennis DTSteere ACLightfoot RWells GShea BTugwell P.

Ottawa Civic Hospital, Ontario, Canada.

Abstract


PURPOSE: To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease. DATA SOURCES: The medical literature was searched for information on outcomes and costs. Expert opinion was sought for information on utilities. 

STUDY SELECTION: Articles that described patient population, diagnostic criteria, dose and duration of therapy, and criteria for assessment of outcomes. 

DATA EXTRACTION: The decision analysis evaluated the following strategies: 1) no testing-no treatment; 2) testing with enzyme-linked immunosorbent assay (ELISA) followed by antibiotic treatment of patients with positive results; 3) two-step testing with ELISA followed by Western blot and antibiotic treatment for patients with positive results on either test; and 4) empirical antibiotic therapy. 

Three patient scenarios were considered: myalgic symptoms, rash resembling erythema migrans, and recurrent oligoarticular inflammatory arthritis. Results were calculated as costs per quality-adjusted life-year and were subjected to sensitivity analysis. 

Adjustment was made for the diagnostic value of common clinical features of Lyme disease. 

DATA SYNTHESIS: For myalgic symptoms without other features suggestive of Lyme disease, the no testing-no treatment strategy was most economically attractive (that is, had the most favorable cost-effectiveness ratio). 

For rash, empirical antibiotic therapy was less costly and more effective than other strategies. For oligoarticular arthritis with a history of rash and tick bite, two-step testing was associated with the lowest cost-effectiveness ratio. 

Testing with ELISA and empirical antibiotic therapy cost an additional $880,000 and $34,000 per quality-adjusted life-year, respectively. For oligoarticular arthritis with one or no other features suggestive of Lyme disease, two-step testing was most economically attractive. 

CONCLUSIONS: Neither testing nor antibiotic treatment is cost-effective if the pretest probability of Lyme disease is low. Empirical antibiotic therapy is recommended if the pretest probability is high, and two-step testing is recommended if the pretest probability is intermediate. 

PMID: 9424980 [PubMed - indexed for MEDLINE]

Free Article


Public Health Rep. 1994 Nov-Dec;109(6):745-9.

Antibiotic therapy for Lyme disease in Maryland.

Strickland GTCaisley IWoubeshet MIsrael E.

Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201.

Abstract


The recommended treatment of Lyme disease is evolving and important questions remain unanswered, such as (a) Are inexpensive oral regimens effective in curing acute illness and preventing arthritic, neurologic, and cardiac manifestations or are much more costly, and potentially toxic, intravenous antibiotics required? (b) Are relatively short 2- to 3-week courses of antibiotics sufficient or are prolonged regimens of a month, or more, better? 

This study reviews antibiotic therapy prescribed by Maryland physicians for the 283 cases reported in 1991 that meet the Centers for Disease Control and Prevention's case definition for Lyme disease. The purpose of the review was to obtain baseline information on the antibiotics being used by physicians in practice to treat patients that they believe have Lyme disease. 

The most frequently prescribed antibiotics for either the 60 percent of patients presenting with erythema migrans or the 40 percent with arthritic, neurologic, or cardiac manifestations were oral doxycycline (47 percent), tetracycline (11 percent), and amoxicillin (13 percent). 

Seventy-one percent of therapeutic courses were for 2 to 3 weeks. Amoxicillin was used in two-thirds of children younger than 8 years. 

Sixty (21 percent) received intravenous therapy, of which ceftriaxone, with or without other antibiotics, was almost always (95 percent) used. 

Intravenous therapy was more frequently given to those with arthritic, neurologic, and cardiac manifestations than to those with erythema migrans (odds ratio = 3.7) and to those with these systemic symptoms along with erythema migrans than to those with erythema migrans alone (odds ratio = 3.8). 

The average course was 2 days longer in treating those with arthritic, neurologic, or cardiac manifestations than in treating those with erythema migrans alone(P = 0.05).

An epidemiologic assessment of antibiotics prescribed by the physicians in Maryland to treat Lyme disease in 1991 shows the choices, dosage, and duration of drugs generally followed those most frequently recommended in the literature. 

Also, it shows that efforts to educate physicians should be directed more towards the diagnosis rather than the treatment of Lyme disease.


Clin Ther. 1998 Sep-Oct;20(5):993-1008; discussion 992.

A cost-of-illness study of Lyme disease in the United States.

Maes ELecomte PRay N.

The Lewin Group, Mechelen, Belgium.

Erratum in:

  • Clin Ther 1999 Feb;21(2):430.

Abstract


Lyme disease produces a diverse clinical picture that can include serious and potentially debilitating cardiac, neurologic, joint, and skin involvement. It is characterized in three stages--early localized (stage I), early disseminated (stage II), and late disseminated (stage III)--and medical management is highly dependent on the stage at which the patient presents and the physician's awareness of available treatment options. 

This study was conducted to establish the medical and economic burden of Lyme disease in the overall US population, which included determining its endemicity in high-risk states and counties, describing current treatment patterns, measuring direct and indirect costs, and defining the cost burden by age group (<18 years and > or =18 years of age). 

Medical, epidemiologic, and economic data were collected, and an algorithm was developed representing the natural course of Lyme disease and the progress of health states over time following medical intervention. 

Using an annual mean incidence of 4.73 cases of Lyme disease per 100,000 population in the decision analysis model yielded an expected national expenditure of $2.5 billion (1996 dollars) over 5 years for therapeutic interventions to prevent 55,626 cases of Lyme disease sequelae. This estimate included both direct medical and indirect costs. 

However, there is evidence of considerable variation in incidence within states. Our findings support development of vaccination strategies for specific target groups.

 PMID: 9829450 [PubMed - indexed for MEDLINE]


Antibiotic Therapy for Lyme Disease in Maryland- Strickland, et al.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403575/pdf/pubhealthrep00057-0027.pdf


The Cost-effectiveness of Vaccination Against Lyme Disease

http://archinte.ama-assn.org/cgi/reprint/161/4/554.pdf\






Last Updated- August 2018

Lucy Barnes

AfterTheBite@gmail.com

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