The Global Burden of Disease Study is a landmark World Health Organization initiative that systematically quantifies the prevalence, morbidity, and mortality for hundreds of diseases, injuries, and risk factors of global health importance. In this article, the authors identify country-specific estimates of the prevalence or incidence of neglected tropical diseases, including cholera, typhoid and scabies.

Aedes albopictus is an invasive mosquito, aggressive biter and potential disease vector. Its establishment in Europe and the Americas resulted in local disease transmission and impacted quality of outdoor recreational activities. Economic implications of its likely invasion into Australia had not been considered. A benefit-cost analysis of an elimination response scenario to an Ae. albopictus incursion in Brisbane was developed with a benefits transfer estimate of the local population's willingness-to-pay for an Ae. albopictus-free environment. Other costed considerations included i) necessary precautionary vector control responses to importations of mosquito-borne diseases (e.g. dengue, Zika) and ii) projected rises in complaints to local government regarding increased mosquito nuisance. Costs of implementing a successful elimination program were estimated between 1 and 4 AU$ per capita, and the annual benefit-cost ratio regarding the value of an unaffected outdoor environment was between 50 and 78. In the event of establishment, annual costs of local government and public health responses were between 0.5 and 1.3 AU$ per capita. The recurrent expense of permanent colonization will be magnified by loss of value associated with an Ae. albopictus-free environment. We conclude it is more cost-beneficial to conduct a thorough elimination program for Ae. albopictus than to allow establishment. (C) 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates …

Background Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013.Methods We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries.Findings We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353-10 649) in 1992, to a peak of 11 302 (6790-13 722) in 2010. This yielded a total of 576 900 (330 000-701200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8.3 million (3.3 million-17.2 million) apparent cases in 1990, to 58.4 million (23.6 million-121.9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566 000 (186 000-1 415 000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1.14 million (0.73 million-1.98 million) disability-adjusted life-years in 2013.Interpretation Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher.

Dengue is currently the most important mosquito-borne viral disease globally. The incidence of dengue has increased substantially over recent decades, with about half of the world’s population now at risk of infection. Vector control is currently the main strategy to reduce dengue virus transmission; however, vector control has not halted the spread of Aedes aegypti, the main dengue vector, and of dengue outbreaks. Promising new vector control technologies could potentially save billions of dollars annually in averted medical costs, productivity losses, and premature deaths. While still under development, genetically modified (GM) sterile insect methods are a potentially promising approach to control dengue. GM mosquitoes have been developed with the goal of producing offspring that die in the early developmental stage, and reducing the mosquito population below the dengue transmission threshold. Here, we present a framework and the main components of an economic analysis to assess GM mosquito technologies. Combining data from various dengue-endemic countries, we generate a mathematical model of costs and benefits and calibrated it with available evidence. We discuss the main assumptions, results, and caveats around these estimates.

Background: With about 100 million apparent infections occurring annually, dengue is a major international public health concern. To date, no specific treatment is available for this disease but the Sanofi Pasteur vaccine candidate has, in 2014, successfully demonstrated its protective efficacy against symptomatic dengue in two Phase 3 efficacy trials performed in five Asian countries (Indonesia, Malaysia, Philippines, Thailand, Vietnam) and 5 Latin American countries (Brazil, Colombia, Honduras, Mexico, Puerto Rico). Methods & Materials: Results observed during the phase 3 efficacy trials were used to fit an age-structured, host-vector, and serotype-specific compartmental model, combined with country-specific information on the cost of dengue illness, dengue routine surveillance data, and population demographics. This model allowed assessing the potential public health and economic impact of various vaccination strategies for the 10 countries in these phase 3 trials. The strategies analyzed included routine vaccination alone (9 year-olds annually) and routine vaccination combined with alternative catch-up campaigns (targeting from 2 to 20 age cohorts and completed in 2, 3 or 4 years). The economic value of vaccination programs was assessed from a societal perspective using WHO criteria for cost-effectiveness, including offsets for medical costs averted. All costs were expressed in 2015 US$. Results: Results indicated that 20% to 30% of dengue cases can be prevented at the population level by using routine vaccination alone. The combination of routine vaccination and the broadest catch-up campaigns could reduce the number of dengue cases in the population over 10 years by 70%. The threshold price per dose for which vaccination can be considered as cost-effective ranged from US$20 to US$100 according to country and vaccination strategy considered, or US$60 to US$300 for the 3 recommended doses. Conclusion: The analysis indicates that the implementation of dengue vaccination programs has the potential to be cost-effective in all 10 endemic countries in the Phase 3 efficacy trials.

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices.Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.92), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the nonMDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened.Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.

Despite considerable reductions in malaria achieved by scaling-up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), maintaining sustained community protection remains operationally challenging. Increasing insecticide resistance also threatens to jeopardize the future of both strategies. Non-pyrethroid insecticide­treated wall lining (ITWL) may represent an alternate or complementary control method and a potential tool to manage insecticide resistance. To date no study has demonstrated whether ITWL can reduce malaria transmission nor provide additional protection beyond the current best practice of universal coverage (UC) of LLINs and prompt case management.

Background Dengue is a serious global burden. Unreported and unrecognised apparent dengue virus infections make it difficult to estimate the true extent of dengue and current estimates of the incidence and costs of dengue have substantial uncertainty. Objective, systematic, comparable measures of dengue burden are needed to track health progress, assess the application and financing of emerging preventive and control strategies, and inform health policy. We estimated the global economic burden of dengue by country and super-region (groups of epidemiologically similar countries).Methods We used the latest dengue incidence estimates from the Institute for Health Metrics and Evaluation's Global Burden of Disease Study 2013 and several other data sources to assess the economic burden of symptomatic dengue cases in the 141 countries and territories with active dengue transmission. From the scientific literature and regressions, we estimated cases and costs by setting, including the non-medical setting, for all countries and territories.Findings Our global estimates suggest that in 2013 there were a total of 58.40 million symptomatic dengue virus infections (95% uncertainty interval [95% UI] 24 million-122 million), including 13 586 fatal cases (95% UI 4200-34 700), and that the total annual global cost of dengue illness was US$8.9 billion (95% UI 3.7 billion-19.7 billion). The global distribution of dengue cases is 18% admitted to hospital, 48% ambulatory, and 34% non-medical.Interpretation The global cost of dengue is substantial and, if control strategies could reduce dengue appreciably, billions of dollars could be saved globally. In estimating dengue costs by country and setting, this study contributes to the needs of policy makers, donors, developers, and researchers for economic assessments of dengue interventions, particularly with the licensure of the first dengue vaccine and promising developments in other technologies.