This study represents only the second study to estimate the burden of NCC using DALYs. The first, which was conducted in Cameroon, estimated human NCC burden based on epilepsy alone 
. The estimated number of DALYs lost per 1,000 person-years was higher in Cameroon (9.0) compared to Mexico (0.25). One difference between the two studies is that all of our data were stratified by urban/rural areas, age groups, and gender. Such stratification was not used in the Cameroon study. Since the majority of the Mexican population is urban, and the proportion of epilepsy cases attributable to NCC is lower in urban areas, the overall burden per person is expected to be lower in Mexico. In addition, NCC-associated epilepsy patients were four times more likely to receive treatment in Mexico than in Cameroon. Because the disability weight for treated epilepsy is much lower than that for untreated epilepsy, this results in fewer DALYS per 1,000 person-years.
Similarly, annual number of deaths due to NCC-associated epilepsy was estimated to be higher (6.9% of the total annual incident cases) in Cameroon compared to Mexico (0.5% of the total annual incident cases). When the current model for Mexico was run using the mortality rate from the Cameroon study, 1.08 (95% CR: 0.8–1.4) DALYs per 1,000 person-years were projected to be lost compared to 0.25 (95% CR: 0.12–0.46) DALYs per 1,000 person-years. This suggests that the high mortality associated with NCC-associated epilepsy in Cameroon had a significant impact on disease burden in that country. Finally, the estimated 9 DALYs lost per 1,000 person-years 
due to NCC-associated epilepsy in Cameroon is three times higher than the 2004 GBD estimate of 2.45 DALYs per 1,000 person-years due to all cases of epilepsy in Cameroon 
. This suggests that the authors may have overestimated the burden of NCC associated epilepsy in that country or else that the GBD estimates for epilepsy were highly conservative.
According to 2004 GBD estimates, 1.7 DALYs per 1,000 person-years were estimated to be lost due to epilepsy in Mexico, with approximately the same number of DALYs lost due to migraine 
. Our estimates for the number of DALYs lost per 1,000 person-years due to NCC was higher than such estimates for other helminthic infections in Mexico (ascariasis-0.05, trichuriasis-0.10, hookworm-0.03) due to the severity of clinical manifestations associated with NCC and because NCC not only causes morbidity, but also mortality in humans 
Our study has some limitations. The total estimated number of DALYs lost was most likely underestimated since only the NCC-associated clinical manifestations of epilepsy and severe chronic headaches were included. There are many other clinical manifestations of NCC 
which could not be included largely due to lack of information on frequency and disability weights. Since data on the incidence of NCC-associated epilepsy and severe chronic headaches were not available, the prevalence was divided by the duration of symptoms to obtain an incidence value. In addition, we assumed that the duration of epilepsy and severe chronic headaches was the same among treated and untreated cases, which is unlikely to be accurate. The mean duration of NCC-associated severe chronic headaches was estimated from the time of diagnosis to the end of symptoms based on the review of medical charts of patients seeking care in tertiary hospitals of Mexico City 
. This may overestimate the true duration of NCC-associated severe chronic headaches if only the most severe cases are seen in tertiary hospitals. On the other hand, it could also lead to an underestimation of the duration since people may wait a long time before seeking care. Due to limited country-specific data, parameters for the proportion of NCC patients with epilepsy and severe chronic headaches and the epilepsy treatment gap were based on systematic reviews of the literature 
Based on the regression sensitivity analysis, the disability weight used for individuals with epilepsy who were greater than 4 years of age was by far the most influential parameter. More precise values of disability weights in future versions of the GBD should reduce the uncertainty. The next most influential values were linked to the prevalence of epilepsy in Mexico. The estimates used here were based on a single study that may not fully reflect the variation of prevalence among the whole country. Better knowledge of the actual prevalence of epilepsy in Mexico would also improve our estimates.
It should be noted that DALY estimates only incorporate human health losses. However, Taenia solium cysticercosis not only causes losses to human health, but also to pig farmers and their communities. Therefore, the total societal burden is higher than that estimated by the number of DALYs lost. An analysis of the monetary burden of NCC in Mexico is currently underway and will be presented in a later publication.
In conclusion, this is the first estimation of the non-monetary burden of NCC in Mexico using the DALY. These estimates suggest that healthy years of life continue to be lost annually in Mexico, with a continued effort needed to control this parasitic disease in endemic regions.