ArticlesGlobal economic burden of Chagas disease: a computational simulation model
Introduction
As Chagas disease continues to expand beyond its traditional range of tropical and subtropical zones, including to regions of the southern USA and Europe, a growing need exists to better understand its resulting economic burden, which in turn could drive much decision making. Policy makers in affected countries must work out where Chagas disease should be placed on their lists of public health, medical, and scientific priorities. Without a comprehensive estimate of the costs associated with Chagas disease, many questions remain. For example, how should policy makers prioritise prevention, education, treatment, and control for Chagas disease? How much should be invested in development of new diagnostic, prevention, and treatment interventions?
Much of the true economic burden of Chagas disease can remain hidden for years. Although up to 10 million people might be currently infected with Trypanosoma cruzi, the causative agent for Chagas disease, many infected individuals can remain asymptomatic for more than a decade. Many such individuals will be unaware that they are infected if not tested—a procedure that is not routine in most locations. However, once clinical problems such as cardiomyopathy, heart failure, and megaviscera (ie, enlargement of the oesophagus or colon) occur, the accompanying health care, disability, and death can be very costly. Moreover, these clinical symptoms are chronic and progressive, accruing costs over many years. There is increasing awareness of widespread Chagas disease in pregnancy with vertical transmission and congenital infection.1, 2 Although a few studies have offered estimates of the annual disability-adjusted life-year (DALY) burden of Chagas disease,3, 4 capturing this hidden future effect will require computational modelling to forecast the downstream effects of currently asymptomatic infections. We aimed to develop a simulation model to estimate the global health and economic burden of Chagas disease from the societal perspective (a commonly used economic perspective that includes health-care costs plus cost related to work absenteeism).5, 6
Section snippets
Model structure
We used TreeAge Pro (version 2009) and Microsoft Excel (version 2007) to develop a Markov computational simulation model, adapted from previously reported models.5, 6 Our Markov model structure had a 1 year cycle length (figure 1). Markov models are useful when a person has different time-dependent risks of undergoing different events or conditions over a long period, especially if the events or conditions can be easily separated into mutually exclusive states. A Markov model allows an
Results
For an individual with chronic disease, our simulations generated an annual health-care cost of $383 (range $207–636) in Latin America, $1762 ($942–2971) in Europe, and $2162 ($1158–3628) in the USA, Canada, and Australia. The global weighted average was $474 ($222–914). Annual DALYs per individual with chronic disease were 0·51 (range 0·38–0·60). The discounted lifetime health-care cost for an individual with T cruzi infection was $2600 (range $1966–3034) in Latin America, $14 948
Discussion
Our results show that on average an infected individual incurs $474 in health-care costs and 0·51 DALYs annually. Over the course of his or her lifetime, an infected individual accrues an average net present value of $3456 and 3·57 DALYs. Globally, the annual burden is $627·5 million in health-care costs and 806 170 DALYs. The global net present value of currently infected individuals is $24·73 billion in health-care costs and 29 385 250 DALYs. Conversion of the entire burden into US$ costs
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