The economic burden of Salmonella infection is substantial, with Africa hit the hardest, according to researchers.
A study, published in the journal BMJ Global Health, estimated the economic burden of invasive non-typhoidal Salmonella (iNTS) in 123 countries.
Salmonella is a major cause of diarrheal disease often transmitted by food or water. However, in some patients it can cause life-threatening invasive infections involving the bloodstream.
The average economic burden per iNTS disease episode ranged from $341 in Africa to $2,194 in Europe but the impact on society was highest in Africa because of the high rates of disease in the region. While the mean economic burden per episode was the lowest in Africa and highest in Europe, this was the opposite for the total economic burden due to iNTS disease.
Various models were tested before one was selected for the estimates. Data came from a previous literature review on the economic burden of iNTS and all forms of NTS disease, such as Salmonella Typhimurium and Salmonella Enteritidis. Field-based economic burden studies (primary data) for iNTS disease were scarce in low- and middle-income countries.
Understanding economic impact
Aggregated economic burden was estimated by multiplying the number of iNTS cases per country by the economic burden of disease per episode.
The iNTS economic burden per episode was estimated to be highest in Thailand at $5,269 and lowest in Nigeria at $18. The burden per episode was estimated to be low for some countries in Africa such as Gabon, Equatorial Guinea, Botswana, South Africa, and Namibia.
At the country level, the highest aggregated economic burden was in China, estimated to be $29.6 million, while the lowest was in Tuvalu, estimated to be $27. The high burden in China was mainly driven by the large population size which resulted in the high number of cases despite the relatively low incidence rate.
Study outcomes were standardized as total costs reflecting direct medical costs, direct non-medical costs, and indirect costs. Four covariates were selected: GDP per capita, life expectancy, population density, and iNTS.
Researchers said there is no commercially available vaccine against iNTS.
“Understanding the economic burden of iNTS disease is important to make a standardized comparison among other health problems competing for countries’ resources. In addition, the substantial economic burden of iNTS disease may be helpful to facilitate priority setting for vaccine investment. Estimating the robust economic burden of iNTS disease is an essential step to assess the value of iNTS-containing vaccines and to measure the cost-effectiveness of various public health interventions, including future vaccination,” the research report states.
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