Economic Burden of Reported Lyme Disease in High-Incidence Areas, United States, 2014–2016

Sarah A. Hook; Seonghye Jeon; Sara A. Niesobecki; AmberJean P. Hansen; James I. Meek; Jenna K.H. Bjork; Franny M. Dorr; Heather J. Rutz; Katherine A. Feldman; Jennifer L. White; P. Bryon Backenson; Manjunath B. Shankar; Martin I. Meltzer; Alison F. Hinckley


Emerging Infectious Diseases. 2022;28(6):1170-1179. 

In This Article

Abstract and Introduction


Approximately 476,000 cases of Lyme disease are diagnosed in the United States annually, yet comprehensive economic evaluations are lacking. In a prospective study among reported cases in Lyme disease–endemic states, we estimated the total patient cost and total societal cost of the disease. In addition, we evaluated disease and demographic factors associated with total societal cost. Participants had a mean patient cost of ≈$1,200 (median $240) and a mean societal cost of ≈$2,000 (median $700). Patients with confirmed disseminated disease or probable disease had approximately double the societal cost of those with confirmed localized disease. The annual, aggregate cost of diagnosed Lyme disease could be $345–968 million (2016 US dollars) to US society. Our findings emphasize the importance of effective prevention and early diagnosis to reduce illness and associated costs. These results can be used in cost-effectiveness analyses of current and future prevention methods, such as a vaccine.


Lyme disease is a bacterial illness caused primarily by infection with Borrelia burgdorferi, transmitted by the bite of infected Ixodes scapularis and I. pacificus ticks in the United States. Early symptoms can include a rash known as erythema migrans and influenza-like symptoms.[1] Disseminated infection can cause neurologic, musculoskeletal, and cardiac complications; in rare cases, cardiac involvement can be fatal.[1–4] Most patients will experience a full recovery after antibiotic treatment, although a minority may continue to experience symptoms related to disease sequelae.[1]

Lyme disease case numbers consistently rank in the top 10 among all nationally notifiable conditions, and it is the most commonly reported vector-borne disease in the United States.[4,5] Annually, >30,000 cases are reported to the Centers for Disease Control and Prevention,[4] but recent studies have demonstrated that the annual number of diagnosed cases is ≈476,000.[6] This figure represents a substantial disease burden, but the total economic cost to US society is unknown.[7]

Economic evaluations for Lyme disease have limitations.[7] Most studies report direct medical costs but lack data on nonmedical costs and losses in productivity.[8–11] Several studies were conducted >2 decades ago in a few Maryland counties where Lyme disease was emerging;[9,11,12] however, this limited scope prevents generalizability to other areas in which the disease is endemic, and results might not be representative of today's costs because of changes in disease management and healthcare structures. More recent studies have used diagnosis codes (e.g., International Classification of Diseases, 9th Revision, Clinical Modification) to identify Lyme disease patients from insurance claims databases. However, the low sensitivity and specificity of these codes in identifying actual cases[13,14] might lead to incorrect estimates of direct medical costs attributable to the disease. The few studies that provide more comprehensive cost estimates of Lyme disease were conducted in Europe under healthcare systems with financing structures different from those of the United States.[15–17] As such, updated estimates of the total societal cost of Lyme disease, including direct and indirect costs, are needed in the United States.[7]

We aimed to address current research gaps by conducting a prospective cost-of-illness study to estimate the economic burden of reported Lyme disease in high-incidence areas of the United States. The main objectives of this study were to estimate the patient cost and the societal cost per participant. The secondary objective was to evaluate the association of select disease and demographic factors with the societal cost per participant. Results can be used by public health officials and communities to assess the cost-effectiveness of interventions to reduce the incidence of Lyme disease.