Profitability and cost-effectiveness analysis of brucellosis control in Armenia: A One Health approach
Authors: Anyanwu Uchenna , Dimov Artemiy , Zinsstag Jakob , Tediosi Fabrizio , Markosyan Tigran 
Published: April 2024

Brucellosis is endemic in the Republic of Armenia and constitutes a financial and public health burden on the nation. Control of the disease is currently using the test-and-slaughter strategy, reportedly at a coverage level deemed insufficient to interrupt transmission by the authorities responsible for disease control. A key aspect of this control strategy is the shared costs between the agricultural and public health sectors. An earlier study conducted by the Advanced One Health Class at the Swiss Tropical and Public Health Institute developed a mathematical-compartmental transmission model to represent the transmission of
Brucella
between cattle, sheep, and humans. The study simulated the performance of the existing control strategy and three other upgraded scenarios over a decade, giving the cumulative incidence of human and livestock prevalence (2022–2031). Based on the cumulative incidence of human and livestock prevalence from 10-year simulations, this study evaluates Armenia’s current brucellosis control program’s profitability, cost-effectiveness, and cost distribution for the existing test-and-slaughter level and three proposed upgraded scenarios in cattle and sheep. In these scenarios, the percentages represent the proportion of animals that were culled when they tested positive for brucellosis: Scenario 1 – 86% of cattle and 65% of sheep; Scenario 2 – 88% of cattle and 70% of sheep; Scenario 3 – 90% of cattle and 75% of sheep. Further estimations were made on public and private health costs, and income loss of human brucellosis patients averted through the different livestock-level interventions. The incremental livestock production and the averted human health cost were summed up as societal benefits of brucellosis interventions. From a societal perspective, the most profitable scenario is estimated to have a net present value of US$ 41.82 million, from an overall cost of US$ 48.27 million and a benefit of US$ 6.45 million, resulting in a benefit-cost ratio of 0.133 at 80% compensation for farmers’ losses and discounted at 5%. From a public health perspective, the cost-effectiveness ratio for the same intervention scenario is US$ 1587 per DALY averted (95% CI: US$ 1268–US$ 2009). When private costs, which are the private income loss and out-of-pocket costs of patients, are added to the public health costs, the cost-effectiveness decreases to US$ 6727 per DALY averted at a 5% discount rate (95% CI: US$ 5371–US$ 8504). These cost-effectiveness and benefit-cost ratios highlight the remarkable disparity in the cost of the test-and-slaughter strategy across the agriculture and public health sectors. Our study highlights the need to reassess the cost-effectiveness of the test-and-slaughter strategy for brucellosis control in Armenia and consider an equitable distribution of the cost of the test-and-slaughter strategy among the sectors as this could facilitate better disease control and cost-effectiveness of the strategy. Armenia should view brucellosis elimination as a public good, justifying public spending for compensation. As seen in other countries, its elimination could boost the economy by lowering trade barriers, making brucellosis-free status a societal benefit.

One Health impact statement

Our study focuses on controlling brucellosis in Armenia using an integrated approach called One Health, which seeks to demonstrate the incremental benefit of closer cooperation between human and animal health and other sectors. We evaluate how profitable and cost-effective test-and-slaughter interventions are in improving the health of both humans and animals while also considering the costs for farmers and the state. Using a One Health approach, we can better understand the cross-sector expenses related to the disease and develop more efficient strategies to interrupt transmission and eventually eliminate the disease. The result is improved animal and human health outcomes, enhanced livelihoods, and a positive contribution to the economy’s overall growth (Narrod
et al
.,
2012
). To carry out this study, we collaborated closely with non-academic partners from the Food Safety and Inspectorate Body (FSIB) and the National Centre for Disease Control in Armenia (NCDC). This collaboration resulted in the creation of valuable knowledge and practical solutions, underscoring the importance of working together across different sectors, including indigenous communities, academia, and non-academic organizations.