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A Method to Estimate the Burden of Foodborne Illness

A Method to Estimate the Burden of Foodborne Illness. Angela Lasher CFSAN-FDA Angela.Lasher@fda.hhs.gov. Total Burden of Foodborne Illness. Health Loss QALDs-QWB and EQ-5D VSL Doctor and hospital costs Visits Medication Lost productivity Work costs Social costs.

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A Method to Estimate the Burden of Foodborne Illness

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  1. A Method to Estimate the Burden of Foodborne Illness Angela Lasher CFSAN-FDA Angela.Lasher@fda.hhs.gov

  2. Total Burden of Foodborne Illness • Health Loss • QALDs-QWB and EQ-5D • VSL • Doctor and hospital costs • Visits • Medication • Lost productivity • Work costs • Social costs

  3. Calculating QALDS Lost- The Quality of Well Being (QWB) Scale QWB= 1 + Symptoms + Mobility + Physical + Social (Kaplan, et al 1993) • Symptom = -0.29 Sick or upset stomach, vomiting, or loose bowel movements, with or w/o fever, chills, or aching all over • Mobility = -0.062 Did not drive car or use public transportation for health reasons; -0.09 In hospital as bed patient overnight • Physical Activity = -0.077 In bed, chair, or couch for most or all of day… • Social Activity = -0.061 Limited or did not perform major or other role activities for health reasons, but performed self-care; -0.106 Did not perform self-care activities or had more help than usual for age

  4. Calculating QALDS Lost- The Kaplan QWB Scale cont.

  5. Calculating QALDS Lost- The EQ-5D Scale

  6. Calculating QALDS Lost- The EQ-5D Scale Cont. • For non-hospitalized illness = 22221 = 0.689; health lost = 0.311 • For hospitalized illness = 22321 = 0.508; health lost = 0.492 Source: Shaw, et. al 2005 (adapts EuroQol Group estimates (GB) for U.S. population)

  7. Comparing QWB and EQ-5D

  8. Values for QALDS and VSL • VSL = $5M and $7M (Viscusi and Aldy 2003) • Starting QALD Value = 1, Avg. for Pop. = 0.84 (IOM report 2006)

  9. Physical and Other Costs • Doctor Visit = ($0, $78) (Finger 2001) • Hospitalization Costs – HCUPnet Data- Healthcare Cost and Utilization Project- AHRQ- Data 2004 • Lost work and social time – incorporated into QALD loss

  10. Bacillus cereus Botulism, Foodborne Brucella spp. Campylobacter spp. Clostridium perfringens E. coli (O157:H7/shiga-toxin and enterotoxigenic, other) Listeria monocytogenes Salmonella (typhoidal and non-typhoidal) Shigella spp. Staphylococcus Streptococcus Vibro (cholerae, vulnificus, other) Yersinia enterocolitica Cryptosporidium parvum Cyclospora cayetanensis Giardia lamblia Toxoplasmosis gondii Trichinella spiralis Norovirus Rotavirus Astrovirus Hepatitis A Nitrates Ammonia Pesticides Marine toxins Illnesses Quantified

  11. Examples of Catalog Usage Illness Burden of an Outbreak: Salmonella Outbreak In July of 2004, the Pennsylvania DOH investigated a Salmonella Javiana outbreak. Illnesses had been reported in 11 counties throughout Pennsylvania. The investigators linked the reported outbreak to Roma tomatoes sold in sandwiches, wraps, and salads. About 330 Pennsylvanians who ate the sandwiches experienced salmonellosis, and the outbreak was believed to have sickened another 80 people in nearby states. • 410 people x 7.8 QALDs lost = 3,198 QALDs lost • 410 people x $9193 = $3.8 million (med. $5M)

  12. Examples of Catalog Usage cont. • FDA proposed a change in 2001 Food Code to reduce the required temperature for cold holding of food in retail and foodservice establishments. FDA proposed to eliminate cold holding food at any refrigerated temperature higher than 41°F. • Some retail and foodservice establishments already cold held foods at 41°F, while others held foods at 45°F or higher. The FDA Listeria Risk Assessment showed that cases of listeriosis could be reduced if baseline cold holding temperatures were universally reduced to 45°F; additional reductions in cases of listeriosis occurred if cold holding temperatures were uniformly reduced from 45°F to 41°F (regardless of time food was kept). • Reduction in listeriosis • 32.27 QALDs saved per illness avoided • $1.1 million saved per illness avoided (med. $5M)

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