Economic Burden of Lyme Disease: Billions in Annual Costs
The economic burden of Lyme disease is substantial. An estimated 240,000 to 440,000 people are diagnosed with Lyme disease each year, with an average of $3,000 spent annually per patient on treatment, according to a study published online in
PLOS ONE.
Treating Lyme disease and its lingering symptoms can cost the healthcare system up to $1.3 billion annually.
“Our study looks at the actual costs of treating patients in the year following their Lyme diagnosis,” says study author Emily Adrion, MS. This involves repeated medical visits and diagnostic tests for symptoms that have not resolved after the initial course of antibiotic treatment.
“It is clear that we need effective, cost-effective, and compassionate management of these patients to improve their outcomes even if we don’t know what to call the disease.”
When diagnosed early, Lyme disease—transmitted by the bite of a tick infected with Borrelia burgdorferi—can usually be treated with a short course of antibiotics. In other cases, the disease can leave lingering symptoms, including fatigue, muscle and joint pain, and cognitive impairments. For a clinical overview of what can persist after treatment, see
Post-Treatment Lyme Disease Syndrome (PTLDS)
and
Lyme Disease Recovery and PTLDS.
The severity and cause of these lingering symptoms remain at the center of an ongoing debate within the medical community. While some physicians refer to persistent symptoms as post-treatment Lyme disease syndrome (PTLDS), which they believe requires no further antibiotic treatment, others describe the condition as chronic Lyme disease and argue that antibiotic treatment beyond the standard 30-day regimen may be necessary.
“Regardless of what you call it,” says Adrion, “our data show that many people who have been diagnosed with Lyme disease are, in fact, going back to the doctor complaining of persistent symptoms, getting multiple tests, and being retreated.”
The severity of chronic symptoms following Lyme disease treatment—and the size of the affected patient population—may be vastly underestimated. Compared with CDC estimates, Johns Hopkins researchers found a significantly higher percentage of patients experiencing persistent symptoms after standard antibiotic treatment.
The study found that 63% of treated patients reported at least one PTLDS-related diagnosis, a rate 36 percentage points higher than those without Lyme disease. In contrast, the CDC estimates that only 10% to 20% of patients experience lingering symptoms after completing 2- to 4-week antibiotic regimens. (For more on why symptoms are often minimized when tests look “normal,” see
Lyme Disease Misconceptions.)
Researchers also reported that individuals with Lyme disease were 5.5 times more likely to receive a diagnosis of debility and excessive fatigue. Within one year of diagnosis, Lyme patients had 87% more physician visits and 71% more emergency room visits than matched controls.
I discussed the economic burden of Lyme disease on society in a 2010 paper entitled
Proof that Chronic Lyme Disease Exists.
A
2002 study
estimated the mean annual cost of Lyme disease to be $16,199 per patient in the United States.
The annual per-patient cost of chronic Lyme disease is substantially higher than many other chronic illnesses, including
$10,911 for fibromyalgia,
$10,716 for rheumatoid arthritis,
and
$13,094 for lupus.
Eighty-eight percent of Lyme disease costs ($14,327 annually) consisted of indirect medical costs, nonmedical costs, and productivity losses. Reducing direct medical costs alone would save, at most, 12%—or $1,872 per year.
In 2002, based on 23,000 cases reported to the Centers for Disease Control and Prevention (CDC), the annual economic cost of Lyme disease in the U.S. was
estimated at $203 million.
Given that the true number of cases is believed to be at least ten times higher than reported, the actual annual cost may approach $2 billion.
In another paper,
Insufficient Evidence to Deny Antibiotic Treatment to Chronic Lyme Disease Patients
,
researchers examined the economic impact of a growing chronic Lyme population using CDC cost data from clinically defined late-stage Lyme disease cases in Maryland’s Eastern Shore.
These cost discussions also intersect with access-to-care barriers many patients face. For related context, see
The Ethics of Lyme Disease Care
and
Preventing Chronic Lyme Disease.
“These patients are lost,” says lead author John Aucott, MD, assistant professor of rheumatology at Johns Hopkins University School of Medicine.
“No one really knows what to do with them. It’s a challenge—but the first thing we need to do is recognize this is a problem.”
If persistent symptoms raise concern for co-infections, clinical evaluation may be warranted. See
Tick-Borne Co-Infections.
