Autor/a:
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Requena-Méndez, Ana; Bussion, Sheila; Aldasoro, Edelweiss; Jackson, Yves; Angheben, Andrea; Moore, David; Pinazo, María Jesús; Gascón i Brustenga, Joaquim; Muñoz, José; Sicuri, Elisa
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Abstract:
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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 euro30
903 406 and euro6 597 403 respectively, with a difference of
euro24 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 euro5442. In the
probabilistic analysis, total costs for the test and no-test
option were euro32 163 649 (95% CI 31 263 705-33 063 593) and
euro6 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 euro6840.75 (95% CI
2545-2759) per QALY gained for a treatment efficacy of 20% and
euro4243 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
euro30000 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. |