The total burden from foodborne illness was about £9 billion ($11.2 billion) in 2018 in the United Kingdom, according to a new report.

based on 2018 figures of 2.4 million foodborne cases per year, the burden for the U.K. from foodborne illness was estimated at £9.1 billion ($11.3 billion) including £3.1 billion ($3.9 billion) for known cases from 13 foodborne pathogens and £6 billion ($7.5 billion) for unattributed cases. The total burden could be as low as £5.3 billion ($6.6 billion) or as high as £13.6 billion ($17 billion).

Cost of illness estimates help the Food Standards Agency (FSA) to assess cost effectiveness of policy interventions, monitor and evaluate food safety measures and allocate resources to control and mitigate such risks.

FSA economists worked with external experts and academics from U.K. universities to develop the Cost of Illness (COI) model to identify and measure costs of a particular disease. A previous FSA COI model attributed an annual cost to foodborne disease in the U.K. of more than £1 billion ($1.25 billion), based on a million infections.

Heather Hancock, chair of the FSA, said: “Being able to put a cost on the personal, social and economic burden when someone becomes ill as a result of food, represents a milestone for the FSA. We will use this new analysis of the cost of illness, and how it varies between different germs, to help set our priorities for tackling foodborne illness and to focus the FSA’s expertise, money and influence.”

Burden by pathogen
Norovirus imposes the most economic and societal burden at an estimated annual cost of £1.7 billion ($2.1 billion) followed by Campylobacter spp. at £712.6 million ($890 million) and Salmonella spp. at £210 million ($262 million). Shiga Toxin-producing E. coli (STEC) O157 with £4 million ($5 million) and Cryptosporidium at £2.1 million ($2.6 million) have the least burden.

Cases of Campylobacter, which are common but generally not severe, impose a burden of £2,380 ($2,900) each while Listeria, the least common of the 13 pathogens measured, has a burden equivalent to £230,748 ($288,000) due to more deaths, resulting in a higher human cost.

In 2018, the average cost per case in the U.K. was £4,000 ($5,000). The Listeria costs per case were 27 times those of E. coli O157 which has the second highest at £8,400 ($10,500). Cryptosporidium has the lowest figure at £1,000 ($1,250), while Campylobacter and Clostridium perfringens also have low costs per case at £2,400 ($3,000) and £1,200 ($1,500) respectively.

The approach used to calculate and estimate the cost of foodborne illness is based on number of cases, severity category such as going or not going to a GP and hospitalization and relevant unit prices including medical costs and wages.

Estimates cover the direct and indirect costs, including those borne by individuals, their carers, businesses and government. It also includes the pain, grief and suffering for individuals and carers, so the human cost of foodborne-related illness, chronic disability and fatalities.

Indirect and direct costs
Financial costs account for more than 20 percent of the total £9.1 billion ($11.3 billion) figure, estimated at £2 billion ($2.5 billion). The majority of this is lost earnings, at £1.8 billion ($2.2 billion), followed by disturbance costs to businesses at £157.5 million ($197 million). Direct financial costs were medical expenses at £60 million ($75 million), costs associated with absence from school at £34.3 million ($42.8 million) and individual expenses at £32 million ($40 million).

The human cost of pain, grief and suffering is estimated at £7.1 billion ($8.9 billion), making up almost 80 percent of the total burden. Illness, including long-term complications and sequelae, make up an estimated £6.8 billion, followed by fatalities valued at £221 million ($276 million). Individuals and carers bear the largest cost of foodborne diseases at £8.9 billion ($11.1 billion). The government has the least with £95 million ($119 million).

Using different models, foodborne pathogens were likely to impose an economic burden on U.S. citizens each year of around $15.5 billion in 2013. Canadian estimates quantified the burden of foodborne disease to the national economy and health care system at almost $2.8 billion ($2 billion) in 2012. Dutch figures put food-related cost of illness at €163 million ($181 million) in 2017.

In 2018, there were an estimated 2.4 million foodborne disease-related cases in the U.K, 16,300 needed hospital treatment and 180 deaths were reported. Norovirus accounts for the most illness at around 383,000 infections, followed by Campylobacter and Clostridium perfringens with around 299,000 and 85,000 respectively. Listeria monocytogenes has the fewest at 162 but 26 of these died so it has the highest proportion of fatalities.

Other work estimating the COI for food hypersensitivities and of food crime and authenticity is ongoing. There are longer term plans to develop an online COI calculator for estimating cost of each of the 13 foodborne pathogens, plus unattributed foodborne illness. The FSA also wants to better understand the burden and costs across the population by demographics and socioeconomics.