usability and communicability of burden of disease methods and outputs

Improving the usability and communication of burden of disease methods and outputs: the BCoDE toolkit application Alessandro Cassini, European Centre for Disease Prevention and Control

Microbiological risk assessment, EFSA@EXPO, Milan, 16 October 2015

BCoDE – Burden of Communicable Diseases in Europe

The BCoDE toolkit application – EFSA@EXPO 2015 16 October 2015

Risk ranking study

“A very relevant subject, given current pressure on health budgets: the allocation of finite disease surveillance and control resources among competing alternatives, infectious diseases in this case.”

-Del Rio Vilas et al., Eurosurveillance, 7 July 2011


Cycle of preparedness activities

Source: ECDC


Approaches to ranking risk

Type of study Notes Examples

Quantitative – Burden of Disease

Most suitable for “established” diseases with strong surveillance data

-ECDC BCoDE study

Quantitative – H-index Bias with regards to what has been published and cited; MERS or SARS would have not shown up

-McIntyre et al, PLoS One, 2010

Quantitative – multi-criteria decision analysis

Stochastic; criteria weighted across experts; provides continuous score

-Havelaar et al, PLoS One, 2010 -Humblet et al, EID, 2012

Semi-quantitative and qualitative

Expert solicitation leading to discrete scores -Cardoen et al, Foodborne Pathogens, 2009 -Gilsdorf & Kraus, Eurosurveillance, 2011

Qualitative – decision algorithms

Based on pre-defined decision-trees; not a ranking approach per se

-Morgan et al, Epidemiol Infect 2009

Qualitative – weighted risk analysis

Simplistic likelihood/magnitude scale -ECDC climate change ranking (Lindgren et al, 2012)

Qualitative – Strategic Foresight, scenario-based

Focus on longer-term time frames and scenarios

-UK Foresight Study -ECDC future threat scenario study


Burden of Communicable Diseases in Europe project (BCoDE)

• ECDC has initiated the BCoDE study in order to assess the comparative impact of infectious diseases in Europe

• A large academic and public health consortium is involved in framing the methodology and developing disease models

• Notified data to ECDC through TESSy is corrected for under-estimation

BCoDE 2015 will soon be published


The Toolkit for burden estimation: a service for EU member states

A user-friendly and ready-to-use toolkit for communicable disease burden estimation will be released in 2015

EU member states and EEA countries are encouraged to employ the toolkit and undergo their national burden of communicable diseases estimation


Introducing the tool: the main page


An embedded tutorial…


…with a walkthrough or pop-ups


Selecting the countries and the diseases


Main inputs: number of cases and factors adjusting for under-estimation


Critically exploring the outcome tree


Running the models


Disease-specific detailed results


Considering the impact of sequelae


Tridimensional bubble charts


Ranking of diseases: the table


Age and gender information


Objectives of the toolkit –

not only a risk ranking exercise


Evidence-based approach to health description


Overview of surveillance data quality and availability


Facilitate communication of complex information to decision makers

• BCoDE 2015 relevant graphs and tables will soon be published on peer-reviewed journals


Provide a tool for planning and prioritisation: ranking of diseases change



Provide a tool for planning and prioritisation: TBE in Slovenia, measles outbreaks, FWDs



In practice

January 2015: EFSA Scientific opinion recommends the BCoDE toolkit as the gold standard top-down approach to rank pathogens (in combination with iRisk)


Questions and thank you For further suggestions, comments and questions please email: [email protected] [email protected]

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