Evidence map›Paper›PMID 34785530›Full record

ArticleCMAJ open

Estimating the population health burden of Lyme disease in Ontario, Canada: a microsimulation modelling approach.

Stephen Mac, Gerald A Evans, Samir N Patel, Eleanor M Pullenayegum, Beate Sander

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.7field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Stephen MacInstitute of Health Policy, Management and Evaluation (Mac, Sander), University of Toronto; THETA Collaborative (Mac, Sander), University Health Network, Toronto, Ont.; Department of Medicine (Evans), Queen's University, Kingston, Ont.; ICES Central (Evans, Sander); Public Health Ontario (Patel, Sander); Department of Laboratory Medicine and Pathobiology (Patel), University of Toronto; The Hospital for Sick Children (SickKids) (Pullenayegum); Dalla Lana School of Public Health (Pullenayegum), University of Toronto, Toronto, Ont. sm.mac@mail.utoronto.ca.
Gerald A EvansInstitute of Health Policy, Management and Evaluation (Mac, Sander), University of Toronto; THETA Collaborative (Mac, Sander), University Health Network, Toronto, Ont.; Department of Medicine (Evans), Queen's University, Kingston, Ont.; ICES Central (Evans, Sander); Public Health Ontario (Patel, Sander); Department of Laboratory Medicine and Pathobiology (Patel), University of Toronto; The Hospital for Sick Children (SickKids) (Pullenayegum); Dalla Lana School of Public Health (Pullenayegum), University of Toronto, Toronto, Ont.
Samir N PatelInstitute of Health Policy, Management and Evaluation (Mac, Sander), University of Toronto; THETA Collaborative (Mac, Sander), University Health Network, Toronto, Ont.; Department of Medicine (Evans), Queen's University, Kingston, Ont.; ICES Central (Evans, Sander); Public Health Ontario (Patel, Sander); Department of Laboratory Medicine and Pathobiology (Patel), University of Toronto; The Hospital for Sick Children (SickKids) (Pullenayegum); Dalla Lana School of Public Health (Pullenayegum), University of Toronto, Toronto, Ont.
Eleanor M PullenayegumInstitute of Health Policy, Management and Evaluation (Mac, Sander), University of Toronto; THETA Collaborative (Mac, Sander), University Health Network, Toronto, Ont.; Department of Medicine (Evans), Queen's University, Kingston, Ont.; ICES Central (Evans, Sander); Public Health Ontario (Patel, Sander); Department of Laboratory Medicine and Pathobiology (Patel), University of Toronto; The Hospital for Sick Children (SickKids) (Pullenayegum); Dalla Lana School of Public Health (Pullenayegum), University of Toronto, Toronto, Ont.
Beate SanderInstitute of Health Policy, Management and Evaluation (Mac, Sander), University of Toronto; THETA Collaborative (Mac, Sander), University Health Network, Toronto, Ont.; Department of Medicine (Evans), Queen's University, Kingston, Ont.; ICES Central (Evans, Sander); Public Health Ontario (Patel, Sander); Department of Laboratory Medicine and Pathobiology (Patel), University of Toronto; The Hospital for Sick Children (SickKids) (Pullenayegum); Dalla Lana School of Public Health (Pullenayegum), University of Toronto, Toronto, Ont.
Public Health Ontario · CASickKids Foundation · CAUniversity of Toronto · CA

Funding

CIHR PJT149087
6 · The paper itself

Abstract

backgroundIf untreated, Lyme disease can lead to long-term sequelae and post-treatment Lyme disease syndrome (PTLDS), resulting in reduced health-related quality of life. The objective of this study was to develop a microsimulation model to estimate the population-level health burden of Lyme disease in Ontario, Canada.

methodsWe developed a Lyme disease history model using microsimulation, simulating 100 000 people (mean age 37.6 yr, 51% female) from 2017 in Ontario over a lifetime risk of infection and time horizon. We extracted the sensitivity and specificity of the 2-tier testing recommended by the Canadian Public Health Laboratory Network, probabilities and health state utility values from the published literature and health administrative data. Our reported outcomes from our stochastic analysis include diagnosed cases of Lyme disease (stratified by stage), undiagnosed infections, sequelae, individuals with PTLDS and quality-adjusted life-years (QALYs) lost.

resultsOur model estimated 333 (95% confidence interval [CI] 329-337) infections over the lifetime of 100 000 simulated people (mean age 37.6 yr, 51% female), with 92% (95% CI 91%-93%) of infections diagnosed. Of those 308 people with Lyme Disease diagnoses, 67 (95% CI 65-69) developed sequelae (e.g., arthritic, cardiac, neurologic sequelae), and 34 (95% CI 33-35) developed PTLDS. Lyme disease resulted in a loss of 84.5 QALYs (95% CI 82.9-86.2) over the lifetime of the simulated cohort. Sensitivity and scenario analysis showed that increasing incidence rates of Lyme disease, potential underreporting, duration of PTLDS and quality of life (health state utility) associated with PTLDS had the greatest impact on health burden.

interpretationLyme disease contributes considerable health burden in terms of QALYs lost. Our analysis provides evidence to understand the disease burden and lays the foundation to assess the cost-effectiveness of pharmaceutical and nonpharmaceutical interventions.

Indexed as

Models, TheoreticalAdultCohort StudiesCost of IllnessCross-Sectional StudiesFemaleHumansLyme DiseaseMaleMiddle AgedOntarioPublic Health SurveillanceQuality-Adjusted Life YearsQuality of LifeYoung Adult

Identifiers

PMID34785530
PMCPMC8598239
OpenAlexW3212201274

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.