Post by Admin/ Traveler on Apr 26, 2019 22:01:03 GMT
Estimation of cumulative number of post-treatment Lyme disease cases in the US, 2016 and 2020
Allison DeLong, Mayla Hsu and Harriet Kotsoris
Received: 27 July 2018
Accepted: 19 March 2019
Published: 24 April 2019
"Abstract:
Background
Lyme disease (LD) is an infectious multi-system illness caused by the bacterial genus Borrelia and spread by bites of infected ticks. Although most patients are successfully treated by timely antibiotic therapy, it is broadly accepted that a sizeable number of patients experience treatment failure and continue to suffer long-term, debilitating symptoms, including pain, fatigue, cognitive dysfunction and other symptoms. This is known as post-treatment LD (PTLD), for which diagnosis is not standardized and treatment remains controversial. The prevalence and societal burden of PTLD is unknown.
Methods
In an effort to help characterize the LD landscape, we estimated the number of PTLD cases in the US in 2016 and 2020 using Monte-Carlo simulation techniques, publically-available demographic datasets, uncertainty in the inputs and realistic assumptions about incidence and treatment failure rates.
Results
Depending on the input assumptions, PTLD prevalence estimates for 2016 ranged from 69,011 persons (95% CI 51,796 to 89,312) to 1,523,869 (CI 1,268,634 to 1,809,416). Prevalence in 2020 is predicted to be higher than 2016, and may be as high as 1,944,189 (CI 1,619,988 to 2,304,147) cases.
Conclusions
The cumulative prevalence of PLTD in the United States is estimated to be high and continues to increase. These findings will be of interest to epidemiologists and health economists studying disease burden in the US and elsewhere, and justify funding to study PTLD diagnosis and treatment.
(Trav here - a few highlights from the rest of the article with some extra spacing, bold text and underlining for making a point)
Yearly incidence of new Lyme infections
Based on direct surveillance reporting to state health departments, there have been approximately 30,000 confirmed cases per year in the United States. However, two recent publications by US CDC researchers suggest that the actual number of new infections is much higher.
Hinckley et al. (2014) estimated about 288,000 new infections in 2008 (range 240,000-444,000) based on surveys of seven national commercial labs that performed Lyme disease testing.
Due to insensitivity in the diagnostic tests currently used by mainstream medical authorities, incidence estimates based solely on these tests are likely to significantly undercount the numbers of infected.
Nelson et al. (2015) used data from a health insurance claims database to estimate there have been approximately 329,000 incident Lyme diagnoses per year during 2005–2010 (range 296,000-376,000).
These publications show that reliance on surveillance, reported by local and regional public health authorities results in significant under-reporting.
Treatment failure
Recent studies have shown that treatment failure rates may range from 10 to 20% [13, 14, 15]. Given the variability of treatment failure due to regional, geographical differences, socioeconomic factors, co-morbidities, treatment delays, and non-standardized treatment protocols, we chose to encompass both extremes of this range, basing our estimations on either 10 or 20%.
Conclusions
Using statistical simulation techniques, we have estimated that the cumulative prevalence of PTLD in the US is high and substantially greater than the yearly incidence. We found that prevalence in 2020 is projected to be higher than 2016, and may be as high as 1,944,189 (CI: 1,619,988 to 2,304,147) cases. These findings are relevant to consideration of expected costs for Lyme disease treatment and the care of those with PTLD.
Allison DeLong, Mayla Hsu and Harriet Kotsoris
Received: 27 July 2018
Accepted: 19 March 2019
Published: 24 April 2019
"Abstract:
Background
Lyme disease (LD) is an infectious multi-system illness caused by the bacterial genus Borrelia and spread by bites of infected ticks. Although most patients are successfully treated by timely antibiotic therapy, it is broadly accepted that a sizeable number of patients experience treatment failure and continue to suffer long-term, debilitating symptoms, including pain, fatigue, cognitive dysfunction and other symptoms. This is known as post-treatment LD (PTLD), for which diagnosis is not standardized and treatment remains controversial. The prevalence and societal burden of PTLD is unknown.
Methods
In an effort to help characterize the LD landscape, we estimated the number of PTLD cases in the US in 2016 and 2020 using Monte-Carlo simulation techniques, publically-available demographic datasets, uncertainty in the inputs and realistic assumptions about incidence and treatment failure rates.
Results
Depending on the input assumptions, PTLD prevalence estimates for 2016 ranged from 69,011 persons (95% CI 51,796 to 89,312) to 1,523,869 (CI 1,268,634 to 1,809,416). Prevalence in 2020 is predicted to be higher than 2016, and may be as high as 1,944,189 (CI 1,619,988 to 2,304,147) cases.
Conclusions
The cumulative prevalence of PLTD in the United States is estimated to be high and continues to increase. These findings will be of interest to epidemiologists and health economists studying disease burden in the US and elsewhere, and justify funding to study PTLD diagnosis and treatment.
(Trav here - a few highlights from the rest of the article with some extra spacing, bold text and underlining for making a point)
Yearly incidence of new Lyme infections
Based on direct surveillance reporting to state health departments, there have been approximately 30,000 confirmed cases per year in the United States. However, two recent publications by US CDC researchers suggest that the actual number of new infections is much higher.
Hinckley et al. (2014) estimated about 288,000 new infections in 2008 (range 240,000-444,000) based on surveys of seven national commercial labs that performed Lyme disease testing.
Due to insensitivity in the diagnostic tests currently used by mainstream medical authorities, incidence estimates based solely on these tests are likely to significantly undercount the numbers of infected.
Nelson et al. (2015) used data from a health insurance claims database to estimate there have been approximately 329,000 incident Lyme diagnoses per year during 2005–2010 (range 296,000-376,000).
These publications show that reliance on surveillance, reported by local and regional public health authorities results in significant under-reporting.
Treatment failure
Recent studies have shown that treatment failure rates may range from 10 to 20% [13, 14, 15]. Given the variability of treatment failure due to regional, geographical differences, socioeconomic factors, co-morbidities, treatment delays, and non-standardized treatment protocols, we chose to encompass both extremes of this range, basing our estimations on either 10 or 20%.
Conclusions
Using statistical simulation techniques, we have estimated that the cumulative prevalence of PTLD in the US is high and substantially greater than the yearly incidence. We found that prevalence in 2020 is projected to be higher than 2016, and may be as high as 1,944,189 (CI: 1,619,988 to 2,304,147) cases. These findings are relevant to consideration of expected costs for Lyme disease treatment and the care of those with PTLD.