# Geographic, demographic and economic burden of human cystic echinococcosis in Italy based on hospital discharge records (2015–2022)

## TL;DR

This study analyzed hospital data to assess the geographic, demographic, and economic impact of cystic echinococcosis in Italy from 2015 to 2022.

## Contribution

The study provides updated insights into the disease's burden and highlights the need for improved surveillance and prevention in southern and insular regions.

## Key findings

- The national average annual hospital prevalence of CE was 0.56 cases per 100,000 inhabitants, with the highest rates in southern and insular regions.
- Hospitalization costs for CE in Italy totaled over €10 million from 2015 to 2022, with more than half of the costs borne by southern and insular regions.
- A downward trend in CE cases was observed, but the disease remains underreported and requires sustained One Health strategies for control.

## Abstract

Cystic echinococcosis (CE) is a neglected zoonotic disease that remains a public-health concern worldwide. However, poor surveillance and incomplete reporting still hinder the calculation of the CE burden. This study evaluated national hospital discharge records (HDRs) from 2015 to 2022 to update CE epidemiological situation and economic impact of human CE in Italy. We reviewed 4,293 HDRs with an echinococcosis diagnosis during 2015–2022. Data extracted included age, sex, residence, nationality, primary versus secondary diagnosis, treatment type, length of stay and discharge outcome. The average annual hospital prevalence was calculated per 100,000 inhabitants and direct hospital costs were derived from records of CE as the primary diagnosis. The 2015–2022 trend was assessed and compared to an extended data set (2001–2022). From 2015 to 2022, 2,663 cases were identified nationally, over half in the southern and insular regions. The national average annual hospital prevalence was 0.56 cases/100,000 inhabitants, peaking in the islands (1.22/100,000 inhabitants). Patients were predominantly adults (>90%) and divided into the following age categories: 25–44 (20.4%), 45–64 (30.2%) and ≥65 years (41.1%); pediatric cases were rare (<3%). The mean hospital stay for primary CE diagnosis was 10.6 days with elderly patients (>65 years) accounting for 70% of in-hospital deaths. National direct hospital costs amounted to €10,726,413, with 56% borne by the South and Islands (South 23%, Islands 33%). A downward trend in hospitalised CE cases was observed from 2015 (326 cases) to 2022 (165 cases), with a notable decline in 2020 linked to the COVID-19 pandemic. Analysis of the longer time period (2001–2022) revealed 1250 fewer cases. These findings confirm CE’s heterogeneous distribution, with persistent hyperendemic foci in traditional pastoral areas driving disproportionate healthcare costs. Sustained One Health surveillance, targeted regional prevention and robust national reporting are critical to further reduce CE burden in Italy.

Cystic echinococcosis (CE) is a parasitic disease transmitted mainly through a dog–sheep cycle, which can also affect humans and more than often results in a severe and costly illness. While there has been a downward trend of CE over the past two decades, the disease remains a concern, particularly in the southern and island regions where sheep farming and close contact between dogs and humans sustain transmission. Using hospital discharge data from 2015 to 2022, we estimated that there were nearly 2,700 cases of CE across the country in eight years, with the highest prevalence in Sardinia and Sicily. The disease primarily affected adults and the elderly, who had the greatest risk of experiencing complications or dying. The hospitalisation costs for CE to the Italian health system raised above €10 million between 2015 and 2022, with more than half of the financial burden falling on the endemic southern and insular regions. Although the number of cases is decreasing, CE is still underreported and requires long-term control strategies, sustained investment and political commitment. Strengthening One Health actions (disease surveillance, veterinary measures, community education) and improving national reporting will help protect people and reduce avoidable healthcare costs.