The burden of Lyme borreliosis expressed in disability-adjusted life years

Eur J Public Health. 2015 Dec;25(6):1071-8. doi: 10.1093/eurpub/ckv091. Epub 2015 Jun 16.


Background: Lyme borreliosis (LB) is the most commonly reported tick-borne infection in Europe and North America. In the last 15 years a 3-fold increase was observed in general practitioner consultations for LB in the Netherlands. To support prioritization of prevention and control efforts for LB, we estimated its burden expressed in Disability-Adjusted Life Years (DALYs).

Methods: We used available incidence estimates for three LB outcomes: (i) erythema migrans (EM), (ii) disseminated LB and (iii) Lyme-related persisting symptoms. To generate DALYs, disability weights and duration per outcome were derived using a patient questionnaire including health-related quality of life as measured by the EQ-5D.

Results: We estimated the total LB burden for the Netherlands in 2010 at 10.55 DALYs per 100,000 population (95% CI: 8.80-12.43); i.e. 0.60 DALYs for EM, 0.86 DALYs for disseminated LB and 9.09 DALYs for Lyme-related persisting symptoms. Per patient this was 0.005 DALYs for EM, 0.113 for disseminated LB and 1.661 DALYs for a patient with Lyme-related persisting symptoms. In a sensitivity analysis the total LB burden ranged from 7.58 to 16.93 DALYs per 100,000 population.

Conclusions: LB causes a substantial disease burden in the Netherlands. The vast majority of this burden is caused by patients with Lyme-related persisting symptoms. EM and disseminated Lyme have a more modest impact. Further research should focus on the mechanisms that trigger development of these persisting symptoms that patients and their physicians attribute to LB.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost of Illness
  • Disabled Persons / psychology
  • Disabled Persons / statistics & numerical data*
  • Female
  • Health Status*
  • Humans
  • Incidence
  • Lyme Disease / physiopathology*
  • Male
  • Netherlands / epidemiology
  • Quality of Life
  • Quality-Adjusted Life Years*
  • Severity of Illness Index
  • Time Factors