Simulation model to estimate the burden of disease due to hepatitis E virus in Dutch pig meat and cost‐effectiveness of control measures

Hepatitis E virus (HEV) can lead to liver disease in humans. In the Netherlands, the consumption of pig meat is thought to be the main contributor to the total burden of disease caused by HEV. In this study, the number of cases and lost disability-adjusted-life-years (DALYs) due to HEV in pig meat were estimated by simulating HEV through the pig supply chain, including the farm, transport, lairage, slaughtering, processing, and consumption stages. The first four stages were modeled using a susceptible-exposed-infected-recovered (SEIR) model. For the last two stages, pig meat and liver products were divided into six product categories commonly consumed by Dutch consumers. Depending on the product category, different ways of heating and storing, leading to the reduction of infectious HEV genome copies, were assumed. Furthermore, the model was challenged by four selected control options at the pig farm: the cleaning of driving boards, the use of predatory flies, the use of rubber mats, and the vaccination of finishing pigs. Finally, the cost-effectiveness of these control measures was estimated by estimating the costs per avoided DALY. For the baseline situation, it was estimated that HEV in pig meat would lead to 70 cases and 21 DALYs per year. All control measures led to a decreased number of DALYs, with vaccination leading to the largest decrease: five DALYs per year. However, the costs per avoided DALY ranged from €0.5 to €7.5 million, making none of the control measures cost-effective unless the control measures are also effective against other pathogens.