The Lancet Global Health
Volume 5, Issue 4, 2017, Pages e439-e447

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis (Article) (Open Access)

Requena-Méndez A.* , Bussion S. , Aldasoro E. , Jackson Y. , Angheben A. , Moore D. , Pinazo M.-J. , Gascón J. , Muñoz J. , Sicuri E.
  • a ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • c ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • d Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
  • e Centre for Tropical Diseases, Sacro-Cuore Don Calabria Hospital, Negrar, Italy
  • f Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
  • g ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • h ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • i ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain
  • j ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Spain, Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom

Abstract

Background Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the Latin American population attending primary care centres in Europe. Methods We constructed a decision tree model that compared the test option (screening of asymptomatic individuals, treatment, and follow-up of positive cases) with the no-test option (screening, treating, and follow-up of symptomatic individuals). The decision tree included a Markov model with five states, related to the chronic stage of the disease: indeterminate, cardiomyopathy, gastrointestinal, response to treatment, and death. The model started with a target population of 100 000 individuals, of which 4·2% (95% CI 2·2–6·8) were estimated to be infected by Trypanosoma cruzi. The primary outcome was the incremental cost-effectiveness ratio (ICER) between test and no-test options. Deterministic and probabilistic analyses (Monte Carlo simulations) were performed. Findings In the deterministic analysis, total costs referred to 100 000 individuals in the test and no-test option were €30 903 406 and €6 597 403 respectively, with a difference of €24 306 003. The respective number of quality-adjusted life-years (QALYs) gained in the test and no-test option were 61 820·82 and 57 354·42. The ICER was €5442. In the probabilistic analysis, total costs for the test and no-test option were €32 163 649 (95% CI 31 263 705–33 063 593) and €6 904 764 (6 703 258–7 106 270), respectively. The respective number of QALYs gained was 64 634·35 (95% CI 62 809·6–66 459·1) and 59 875·73 (58 191·18–61 560·28). The difference in QALYs gained between the test and no test options was 4758·62 (95% CI 4618·42–4898·82). The incremental cost-effectiveness ratio (ICER) was €6840·75 (95% CI 2545–2759) per QALY gained for a treatment efficacy of 20% and €4243 per QALY gained for treatment efficacy of 50%. Even with a reduction in Chagas disease prevalence to 0·05% and with large variations in all the parameters, the test option would still be more cost-effective than the no-test option (less than €30000 per QALY). Interpretation Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a cost-effective strategy. Findings of our model provide an important element to support the implementation of T cruzi screening programmes at primary health centres in European countries hosting Latin American migrants. Funding European Commission 7th Framework Program. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Author Keywords

[No Keywords available]

Index Keywords

electrophysiology South and Central America decision tree antiprotozoal agent enteropathy Cost benefit analysis Antiprotozoal Agents mass screening economics Latin America Europe health care personnel human epidemiology statistics and numerical data priority journal sensitivity analysis ethnology benznidazole health care cost Humans migrant electrocardiography male Emigrants and Immigrants blood cell count female risk factor enzyme linked immunosorbent assay hidden Markov model Holter monitoring Monte Carlo Method prevalence Article organization and management economic evaluation adult thorax radiography chemiluminescence immunoassay Chagas Disease implantable cardioverter defibrillator cost-benefit analysis cardiomyopathy population migration Trypanosoma cruzi primary health care program cost effectiveness
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014019876&doi=10.1016%2fS2214-109X%2817%2930073-6&partnerID=40&md5=390c947b3f422d48bd183bb246083370
DOI: 10.1016/S2214-109X(17)30073-6
ISSN: 2214109X
Cited by: 25
Original Language: English