{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:11:01Z","timestamp":1779394261965,"version":"3.53.1"},"reference-count":32,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Lyme disease, the most common vector-borne disease in Minnesota, is estimated to be underreported by a factor of 10. Delayed diagnosis and misdiagnosis may lead to health complications and increased personal and societal costs. Environmental factors can help to predict high disease years, allowing for early intervention to decrease disease burden.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    To estimate the health and cost burdens of Lyme disease and the extent to which they could be diminished by public health intervention when high-incidence Lyme disease years are forecasted.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We used 5 two-dimensional Monte Carlo simulations to estimate (1) average annual expected burden of Lyme disease, (2 and 3) average burden in low- and high-incidence years, and (4 and 5) the expected burden saved with public health educational interventions preceding high-incidence years. We employed cases reported to the Minnesota Department of Health adjusted for estimates of underreporting found in the literature.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Among an average of 8436 Lyme disease cases annually, 6074 of them were unidentified. High-incidence years saw over 3700 more cases than low-incidence years, with incremental costs to patients and society exceeding $3 million. We estimated that public health education before high-incidence years could reduce Lyme disease cases by 390 to 787 annually, saving up to $1.9 million in societal costs.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Discussion:<\/jats:bold>\n                    The simulations presented revealed substantial health and cost burden from Lyme disease, including hidden impacts from undiagnosed and unreported cases. Burden varied widely between high- and low-incidence years, highlighting the need to prioritize prevention when peak years are predicted. While we estimated the effects of individual prevention measures, real-world interventions often combine strategies, potentially producing a greater, multiplicative impact, suggesting our estimates may be conservative.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Simulation modeling demonstrates Lyme disease\u2019s significant impact on individuals and society. Annual forecasting-triggered public health interventions could reduce cost and disease burden, and these findings may help justify the cost of prevention efforts in policy decision-making.\n                  <\/jats:p>","DOI":"10.36469\/001c.146618","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T17:56:40Z","timestamp":1763661400000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the Public Health Impact of Lyme Disease in Minnesota: A Simulation Analysis of Reported and Unreported Cases"],"prefix":"10.36469","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1552-9076","authenticated-orcid":true,"given":"Kathleen E.","family":"Angell","sequence":"first","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Jana","family":"Broadhurst","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianghu J.","family":"Dong","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzeyu L.","family":"Michaud","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Degarege","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cortinas","sequence":"additional","affiliation":[{"name":"University of Nebraska, Lincoln, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Brett-Major","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.3201\/eid2806.211335","article-title":"Economic burden of reported Lyme disease in high-incidence areas, United States, 2014-2016","volume":"28","author":"S. A. Hook","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"560018","DOI":"10.3389\/fmed.2020.560018","article-title":"Risk factors and outcomes of treatment delays in Lyme disease: a population-based retrospective cohort study","volume":"7","author":"A. G. Hirsch","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/1471-2334-9-79","article-title":"Diagnostic challenges of early Lyme disease: lessons from a community case series","volume":"9","author":"J. Aucott","year":"2009","journal-title":"BMC Infect Dis"},{"issue":"3","key":"ref4","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s10393-023-01656-5","article-title":"Environmental drivers of immature <i>Ixodes scapularis<\/i> in Minnesota's metro area","volume":"20","author":"J. 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Daltroy","year":"2007","journal-title":"Health Educ Behav"},{"issue":"7","key":"ref8","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1111\/zph.12984","article-title":"Effectiveness of personal protection measures against Lyme disease: a review of epidemiologic studies from the United States","volume":"69","author":"A. M. Schwartz","year":"2022","journal-title":"Zoonoses Public Health"},{"issue":"2","key":"ref9","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3201\/eid1402.070725","article-title":"Effectiveness of personal protective measures to prevent Lyme disease","volume":"14","author":"M. Vazquez","year":"2008","journal-title":"Emerg Infect Dis"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000002140","article-title":"Active and passive vector surveillance systems in Lyme endemic Minnesota and their correlation to human disease","volume":"2025","author":"K. E. Angell","journal-title":"J Public Health Manag Pract"},{"key":"ref11","article-title":"Diseases that can be transmitted by ticks","author":"Minnesota Department of Health","year":"2024"},{"key":"ref12","article-title":"Latest annual estimates of Minnesota and its 87 counties' population and households, 2022","author":"Minnesota State Demographic Center"},{"issue":"1","key":"ref13","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s12962-021-00260-0","article-title":"Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds","volume":"19","author":"R. Daroudi","year":"2021","journal-title":"Cost Eff Resour Alloc"},{"issue":"1","key":"ref14","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1080\/10810730.2017.1414900","article-title":"How message fatigue toward health messages leads to ineffective persuasive outcomes: examining the mediating roles of reactance and inattention","volume":"23","author":"S. Kim","year":"2018","journal-title":"J Health Commun"},{"issue":"1","key":"ref15","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12913-023-09140-0","article-title":"Factors associated with delaying medical care: cross-sectional study of Nebraska adults","volume":"23","author":"K. L. Ratnapradipa","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref16","article-title":"The state of health insurance coverage in the U.S. - findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey","author":"The Commonwealth Fund","year":"2024"},{"issue":"7","key":"ref17","doi-asserted-by":"publisher","first-page":"e451","DOI":"10.1161\/CIRCULATIONAHA.112.101485","article-title":"Cardiology patient pages. Lyme disease and the heart","volume":"127","author":"P. J. Krause","year":"2013","journal-title":"Circulation"},{"issue":"4","key":"ref18","doi-asserted-by":"publisher","first-page":"E1005","DOI":"10.9778\/cmajo.20210024","article-title":"Estimating the population health burden of Lyme disease in Ontario, Canada: a microsimulation modelling approach","volume":"9","author":"S. Mac","year":"2021","journal-title":"CMAJ Open"},{"issue":"1","key":"ref19","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/s12889-019-6681-9","article-title":"Estimation of cumulative number of post-treatment Lyme disease cases in the US, 2016 and 2020","volume":"19","author":"A. DeLong","year":"2019","journal-title":"BMC Public Health"},{"issue":"2","key":"ref20","doi-asserted-by":"publisher","first-page":"e0116767","DOI":"10.1371\/journal.pone.0116767","article-title":"Health care costs, utilization and patterns of care following Lyme disease","volume":"10","author":"E. R. Adrion","year":"2015","journal-title":"PLoS One"},{"issue":"6","key":"ref21","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1080\/00365540110080421","article-title":"5-y Follow-up study of patients with neuroborreliosis","volume":"34","author":"J. Berglund","year":"2002","journal-title":"Scand J Infect Dis"},{"key":"ref22","article-title":"Lyme disease","author":"US Centers for Disease Control and Prevention"},{"issue":"6","key":"ref23","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1093\/eurpub\/ckv091","article-title":"The burden of Lyme borreliosis expressed in disability-adjusted life years","volume":"25","author":"C. C. van den Wijngaard","year":"2015","journal-title":"Eur J Public Health"},{"issue":"6","key":"ref24","doi-asserted-by":"publisher","first-page":"911","DOI":"10.3201\/eid1606.090329","article-title":"Evolution of Northeastern and Midwestern Borrelia burgdorferi, United States","volume":"16","author":"D. Brisson","year":"2010","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"ref25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17051548","article-title":"Comparing the climatic and landscape risk factors for Lyme disease cases in the Upper Midwest and Northeast United States","volume":"17","author":"Y. Dong","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1016\/j.idm.2020.10.004","article-title":"Estimates for Lyme borreliosis infections based on models using sentinel canine and human seroprevalence data","volume":"5","author":"M. J. Cook","year":"2020","journal-title":"Infect Dis Model"},{"issue":"5","key":"ref27","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/cid\/ciu397","article-title":"Lyme disease testing by large commercial laboratories in the United States","volume":"59","author":"A. F. Hinckley","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"9","key":"ref28","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.3201\/eid2109.150417","article-title":"Incidence of clinician-diagnosed Lyme disease, United States, 2005-2010","volume":"21","author":"C. A. Nelson","year":"2015","journal-title":"Emerg Infect Dis"},{"issue":"11","key":"ref29","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1001\/jama.2013.278331","article-title":"CDC estimates 300,000 US cases of Lyme disease annually","volume":"310","author":"B. M. Kuehn","year":"2013","journal-title":"JAMA"},{"issue":"2","key":"ref30","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1111\/zph.12291","article-title":"Underreporting of Lyme and other tick-borne diseases in residents of a high-incidence county, Minnesota, 2009","volume":"65","author":"E. K. 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