The socio-economic burden of cystic echinococcosis in Morocco: A combination of estimation method.

Cystic echinococcosis (CE) is a major zoonosis in Morocco despite the launch of a national control programme in 2005. As its economic consequences have not been studied yet in Morocco, this study estimated CE impact in terms of monetary losses, disability-adjusted life years (DALY), and DALY for zoonotic diseases (zDALY) in the entire country and in specific regions for the 2011 to 2014 period. The direct monetary losses were related to organ seizure from infected animal in slaughterhouses, and to healthcare expenses as well as lost wages for infected humans. Animal production losses concerned milk yield, fertility, carcass weight, and wool production. Losses due to human infection were also composed of disability and productivity losses at work. Monte Carlo simulations were used to estimate monetary losses and zDALY values. Nationwide, the estimated DALY was 0.5 years per 100,000 persons per year, and the zDALY was 55 years per 100,000 persons per year. Total yearly losses were estimated at 73 million USD (54-92 million USD). However, losses differed significantly among regions. Most of the economic losses consisted of unperceived consequences, i.e. decreased animal production and reduced productivity of asymptomatic individuals. Future studies should determine the socioeconomic and epidemiological factors underlying the differences in economic losses among regions to develop better adapted control programmes. Author summary Cystic echinococcosis (CE) is a major neglected zoonosis in Morocco, despite the launch of a national control programme in 2005. The first study on CE in Morocco dates back to 1924. However, no evaluation of economic losses was made until now. The present study estimated the economic losses caused by CE in Morocco, at the national and regional scale, by combining financial and non-financial methods. Estimation of the direct and indirect losses caused by CE infection in humans and livestock (sheep, cattle, goats and camels) highlighted the important disease burden nationwide, amounting to 0.07% of Morocco Gross Domestic Product. The combination of methods brought information on the different CE-linked economic losses, including the unperceived consequences. These results indicate that the national CE control strategy did not result in a decrease of the disease burden, which calls for its evaluation and improvement.