Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans

Abstract Background Leptospirosis, a prevalent zoonotic disease with One Health priority and a disease of poverty, lacks global economic burden estimates. This study aims to determine the global, regional, and country-level cost of leptospirosis due to loss of productivity. Methodology/Principal Findings The cost of leptospirosis due to loss of productivity (referred to as productivity cost hereafter) was estimated by converting the disability-adjusted life years (DALYs) lost due to leptospirosis to a monetary value using the per capita gross domestic product (GDP). The country-specific DALYs lost were obtained from the global burden of leptospirosis study published previously. For the cost conversion of DALYs, non-health GDP per capita (GDP-per capita health expenditure) was used. Country-specific GDP and health expenditure data were obtained from the World Bank data repositories. Estimates were done using both nominal and international dollars. The estimated global productivity cost of leptospirosis in 2019 was Int$ 29.3 billion, with low and high estimates ranging from Int$ 11.6 billion to 52.3 billion. China (Int$ 4.8 billion), India (Int$ 4.6 billion), Indonesia (Int$ 2.8 billion), Sri Lanka (Int$ 2.1 billion), and the United States (Int$ 1.3 billion) had the highest productivity cost due to leptospirosis. Eight out of 10 countries with the highest burden were in the Asia-Pacific region. In addition, lower middle-income countries had an annual productivity cost of Int$ 13.8 billion, indicating that the disease is poverty-related. Conclusion Although significant, the cost estimate due to loss of productivity is merely a fraction of the overall economic burden of this disease, which also includes other direct, indirect, and intangible costs. The existing partial estimates of the different components of economic cost suggest a profound economic burden that demands the inclusion of leptospirosis in the global health agenda for comprehensive disease control and prevention efforts, including vaccine development. Author Summary Leptospirosis is a widespread disease that affects humans and animals and is mostly affecting individuals living in resource-poor settings, in particular in tropical and subtropical regions. To understand the economic impact of this disease, we estimated the cost of this disease, assuming that all deaths and disabilities due to the disease will lead to a loss of human productivity. The country-level estimates were done using the published data from the World Bank on per capita gross domestic product (GDP) after removing the per capita health expenditure from the GDP. The estimated average annual cost of leptospirosis due to loss of productivity was $29.3 billion in 2019, which could be as high as $52.3 billion. The countries with the highest costs were China ($4.8 billion), India ($4.6 billion), Indonesia ($2.8 billion), Sri Lanka ($2.1 billion), and the United States ($1.3 billion). Most countries with the highest costs were in the Asia-Pacific region, and lower-middle-income countries had an annual cost of 13.8 billion US dollars. The estimate of lost productivity represents, however, a fraction of the overall economic burden caused by leptospirosis, highlighting the need for immediate action to control and eliminate the disease and its inclusion in the global health agenda.