In a study of the economic impact of West Nile virus (WNV) in the United States, a research team from the Centers for Disease Control and Prevention (CDC) reports that in the 14 years since the virus was first detected in New York, hospitalized cases of WNV disease have cost a cumulative $778 million in health care expenditures and lost productivity.
The findings are the result of an analysis published online today in the American Journal of Tropical Medicine and Hygiene (AJTMH).
West Nile virus became a familiar phrase to Americans in 1999 when news reports of serious infection and deaths from the virus first emerged. Until then, West Nile virus – which is spread to humans by the bite of an infected mosquito – had not been detected outside of the Eastern Hemisphere.
Annual outbreaks have continued to occur across the United States, such as the large outbreak in Dallas in 2012.
More than 37,000 WNV disease cases have been reported to CDC since 1999, and this number likely underestimates the total number of infections that occurred in the United States.
About one in five people who are infected with the virus will develop a fever with other symptoms such as headache and joint pains, but about one in 150 of those infected develop a serious nervous system illness such as encephalitis or meningitis that typically requires hospitalization.
Little is known about the longer-term health needs of individuals affected by WNV disease or the economic cost of the disease to the nation.
The study looked at the costs of initial hospitalization of WNV patients and long-term direct and indirect costs in the five years following their hospitalization – from follow-up doctor visits and medications to how much job or school time was missed.
“We believe that previous costs associated with West Nile virus disease have been underestimated because they've predominantly focused on the costs of the initial illness,” said J. Erin Staples, MD, PhD, a medical epidemiologist at CDC in Fort Collins, Colorado, and the study's lead author. “Many hospitalized patients will incur additional medical and indirect costs, and these need to be figured into the burden of WNV disease. Only with accurate figures can public health, academic, and industry officials determine the cost effectiveness of local mosquito control measures or of developing new drugs and vaccines.”
To address this area, the research team determined the cost of initial hospitalization for 80 patients during a 2003 outbreak in Colorado.
For a subset of these patients, they then calculated costs of additional related medical care and missed work incurred in the five years after the initial infection.
To estimate the total cost of WNV disease to the nation, the research team extrapolated those costs to the total number of hospitalized cases of WNV disease reported to CDC since 1999. Those findings suggest an annual burden of $56 million in the United States.
Economic impact for the four major clinical syndromes of WNV
This is the first published study to calculate these costs for the four specific “clinical syndromes” of the disease: fever, meningitis, encephalitis and acute flaccid paralysis, the more severe of which can lead to death or long-term disability.
The 37,088 WNV disease cases reported to CDC from 1999 through 2012 included more than 16,000 patients with neurologic disease, over 18,000 patients who required hospitalization, and over 1,500 deaths.
According to the CDC, individuals over 50 years of age are more likely to develop severe neurologic disease if infected.
The researchers found that short-term and long-term costs for individuals hospitalized with WNV disease varied widely and depended on the clinical syndrome encountered.
“We broke down costs by clinical syndrome and were surprised by what we found. While patients with meningitis had shorter hospital stays than others with neurological syndromes, they were also younger and more likely to miss work, which translated to a higher economic cost in lost productivity,” Staples said. “Encephalitis patients tended to be older, with many of them retired, so the cost associated with lost productivity was lower.”
Patients who were hospitalized with acute flaccid paralysis, a partial- to whole-body paralysis caused by WNV infection, had the largest initial and long-term medical costs (median $25,000 and $22,000 respectively).
All of them required long-term care to help regain lost function, which increased costs. Patients who were hospitalized for meningitis and those hospitalized for fever incurred similar costs of initial hospitalization (median $7,500). Most meningitis and fever patients did not require long-term care.
Among patients in the study, the average age at initial diagnosis was 55 years, and one-fourth of patients were over 65 years of age. Hospitalized patients were absent from work or school for a median 42 days due to their illness.
Data from CDC national disease surveillance system
Researchers were able to make national cost estimates due to the efforts of physicians and state public health officials who report confirmed WNV disease cases to the CDC ArboNET surveillance system.
CDC uses ArboNET to track the incidence of WNV disease as well as other diseases caused by arthropod-borne viruses (arboviruses) transmitted by mosquitoes or ticks such as dengue, La Crosse, eastern equine encephalitis, and Powassan viruses.
“National surveillance efforts are critical to determining where and when outbreaks of mosquito or tick-borne diseases occur,” Staples said. “Being able to react quickly to an outbreak and put in place preventive measures such as emptying outdoor water containers, wearing insect repellant and potentially beginning community-wide insecticide spraying is essential to limiting both the public health threat and the long-term economic cost of vector-borne infectious diseases.”
In an accompanying AJTMH editorial, Alan D. T. Barrett, PhD, a tropical viral disease specialist at the University of Texas Medical Branch, Galveston, Texas, writes that studies such as this “are critical to assessing cost-effectiveness of prevention and therapeutic countermeasures and various intervention strategies, and are important in helping guide public health decisions.”
“There are a number of candidate vaccines and antiviral drugs in development, and the figures for economic burden reported in this paper will aid policy makers and pharma to assess the economics of vaccine and drug development,” he adds.
West Nile virus most likely entered the United States inadvertently through animals or mosquitoes imported from Europe or the Middle East. Human infections were first identified in New York City in late summer 1999. The virus then quickly spread across the entire continental United States in less than 5 years.
As recent outbreaks confirm, WNV is firmly entrenched in the United States and seasonal outbreaks can be expected to recur annually. Several potential vaccines for WNV are being tested, but none are yet available to vaccinate the general public.
“Understanding the economic impact of disease is an increasingly important data point for the public health community and policy makers,” said Alan J. Magill, MD, FASTMH, president of the American Society of Tropical Medicine and Hygiene, which publishes the journal. “As we all strive for the most efficient and effective use of scarce resources, studies like this offer decision makers facts that will help them make sound funding and policy decisions.”
LAKEPORT, Calif. – The Mobile Health Services Unit, Sutter Lakeside Hospital’s medical-office-on-wheels, will be located at Judy’s Junction in Upper Lake on the second, fourth and fifth Tuesdays of each month starting Feb. 11.
On the first and third Tuesdays of each month, the Mobile Health Services Unit (MHSU) will continue to be located at Upper Lake High School.
The MHSU will be located in the following locations in Lake County:
To see the schedule online, please go to http://www.sutterlakeside.org/pat-services/mhsu-general.html .
The MHSU also offers access to Sutter Electronic Health Records. This ability to electronically view patient health information will improve patient care by allowing care teams to have real-time access to patients’ medical histories, including allergies, medications and test results. Lab, imaging, respiratory therapists and other clinicians can also view when care steps are scheduled.
The Mobile Health Services Unit serves approximately 600 people in Lake County each year.
The MHSU was purchased through gifts from the Lake County community, coupled with a matching grant from Sutter Health.
Each weekday, the MHSU travels to a different location around Clear Lake, bringing medical care directly to those who need it most.
The MHSU has two exam rooms, runs off solar energy and is ADA compliant.
Certified Physician Assistant Brad Greaves sees patients of all ages, from babies and children to senior citizens.
While the MHSU is not a free clinic, it provides financial assistance if patients meet certain income and family size requirements.
The MHSU also offers a 25-percent discount for medical bills that are paid in a timely manner.
The MHSU accommodates both walk-ins and scheduled appointments.
To schedule an appointment or to find out more information about services that the Mobile Health Services Unit provides, please call 707-262-5076.
New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that higher consumption of yogurt, compared with no consumption, can reduce the risk of new-onset type 2 diabetes by 28 percent.
Scientists at the University of Cambridge found that in fact higher consumption of low-fat fermented dairy products, which include all yogurt varieties and some low-fat cheeses, also reduced the relative risk of diabetes by 24 percent overall.
Lead scientist Dr. Nita Forouhi, from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, said, “This research highlights that specific foods may have an important role in the prevention of type 2 diabetes and are relevant for public health messages.”
Dairy products are an important source of high quality protein, vitamins and minerals. However, they are also a source of saturated fat, which dietary guidelines currently advise people not to consume in high quantities, instead recommending they replace these with lower fat options.
Previous studies on links between dairy product consumption (high fat or low fat) and diabetes had inconclusive findings. Thus, the nature of the association between dairy product intake and type 2 diabetes remains unclear, prompting the authors to carry out this new investigation, using much more detailed assessment of dairy product consumption than was done in past research.
The research was based on the large EPIC-Norfolk study which includes more than 25,000 men and women living in Norfolk, UK.
It compared a detailed daily record of all the food and drink consumed over a week at the time of study entry among 753 people who developed new-onset type 2 diabetes over 11 years of follow-up with 3,502 randomly selected study participants.
This allowed the researchers to examine the risk of diabetes in relation to the consumption of total dairy products and also types of individual dairy products.
The consumption of total dairy, total high-fat dairy or total low-fat dairy was not associated with new-onset diabetes once important factors like healthier lifestyles, education, obesity levels, other eating habits and total calorie intake were taken into account.
Total milk and cheese intakes were also not associated with diabetes risk. In contrast, those with the highest consumption of low-fat fermented dairy products (such as yogurt, fromage frais and low-fat cottage cheese) were 24 percent less likely to develop type 2 diabetes over the 11 years, compared with nonconsumers.
When examined separately from the other low-fat fermented dairy products, yogurt, which makes up more than 85 percent of these products, was associated with a 28 percent reduced risk of developing diabetes.
This risk reduction was observed among individuals who consumed an average of four and a half standard 125g pots of yogurt per week. The same applies to other low-fat fermented dairy products such as low-fat unripened cheeses including fromage frais and low-fat cottage cheese.
A further finding was that consuming yogurt in place of a portion of other snacks such as crisps also reduced the risk of developing type 2 diabetes.
While this type of study cannot prove that eating dairy products causes the reduced diabetes risk, dairy products do contain beneficial constituents such as vitamin D, calcium and magnesium. In addition, fermented dairy products may exert beneficial effects against diabetes through probiotic bacteria and a special form of vitamin K (part of the menaquinone family) associated with fermentation.
The authors acknowledge the limitations of dietary research which relies on asking people what they eat and not accounting for change in diets over time, but their study was large with long followup, and had detailed assessment of people's diets that was collected in real-time as people consumed the foods, rather than relying on past memory.
The authors conclude that their study therefore helps to provide robust evidence that consumption of low-fat fermented dairy products, largely driven by yogurt intake, is associated with a decreased risk of developing future type 2 diabetes.
“At a time when we have a lot of other evidence that consuming high amounts of certain foods, such as added sugars and sugary drinks, is bad for our health, it is very reassuring to have messages about other foods like yogurt and low-fat fermented dairy products, that could be good for our health,” said Dr. Forouhi.
WASHINGTON, D.C. – U.S. Reps. Mike Thompson (CA-5) and Anna Eshoo (CA-18) have introduced H.R. 3986, the Fair Access to Health Care Act.
The legislation would expand the eligibility for premium tax credits for people living in high-cost areas who purchase health insurance through the federal and state exchanges set up by the Affordable Care Act (ACA).
“A middle class income means different things in different parts of the country,” said Thompson. “In some California cities, the cost of living is far higher than the national average. Because of the across-the-board income thresholds set by the ACA, some hard working families in high-cost areas like ours don’t qualify for subsides and therefore can’t get affordable insurance. This bill will help make affordable health insurance a reality, no matter where someone lives.”
“The Affordable Care Act is helping low to middle-income Americans buy private health insurance with subsidies adjusted to their income level,” said Eshoo. “While this is tremendously helpful to millions of individuals and families, there are others in high-cost areas, like those in my home district of Silicon Valley, who cannot benefit because the threshold to qualify for subsidies does not account for the cost of living. The Fair Access to Health Act ties health insurance subsidies to the cost of living of a geographic area instead of to the national federal poverty level. In doing so, we can expand access to health insurance and improve our nation’s health.”
Currently the ACA allows those making between 138 and 400 percent of the federal poverty level (FPL) to qualify for premium tax credits to help them purchase health insurance through the ACA’s exchanges.
At this level, an individual making up to $45,960 and a family of four making up to $94,200 qualify for premium tax credits.
However, the income threshold used to determine eligibility for these tax credits doesn’t take into account the cost of living for different geographic areas.
A family living in New York City or San Francisco is treated the same as a family living in a small town in South Carolina or Texas.
The Fair Access to Health Care Act would allow the premium tax credits offered through the ACA to be increased proportionally based on an area’s cost of living.
Under the bill, the federal poverty level threshold will increase proportionally based on an area’s cost of living above the national average cost-of-living.
The cost-of-living is determined using the Census Bureau’s Supplemental Poverty Measure (SPM).
For example, using this calculation:
Precedent already exists in the ACA for such cost-of-living adjustments. The ACA accounts for the cost-of-living differences in Alaska and Hawaii by using a higher income threshold to determine subsidy eligibility. The Fair Access to Health Care Act would provide similar adjustments to the other 48 states.
Individuals and families from low-cost geographical areas will not be impacted by this legislation. Those earning up to 400 percent of the FPL would still be eligible for subsides and no region would see a reduction from their current subsidy level.