Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening.

Eileen Stillwaggon,Stephanie R Bialek,Victoria Perez-Zetune,Susan P Montgomery

doi:10.4269/ajtmh.17-0818

Abstract

.Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.

Highlights

Chagas disease, called American trypanosomiasis, is caused by Trypanosoma cruzi, which is spread by triatomine insect vectors.[1,2] Infected insects are found from southern South America to the southern states of the United States, vector transmission to humans is very rare in the United States.[3,4,5] Vector control has been very successful in many endemic regions.[1,2,6] Transmission can occur through blood transfusions, organ transplantation, consumption of insect feces in food, and from mother to child during gestation.[3]
This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States
We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program

Summary

Introduction

Called American trypanosomiasis, is caused by Trypanosoma cruzi, which is spread by triatomine insect vectors.[1,2] Infected insects are found from southern South America to the southern states of the United States, vector transmission to humans is very rare in the United States.[3,4,5] Vector control has been very successful in many endemic regions.[1,2,6] Transmission can occur through blood transfusions, organ transplantation, consumption of insect feces in food, and from mother to child during gestation.[3] Almost all endemic countries have instituted screening of blood products.[1,2] Despite the existence of domestic and wild animal reservoirs, significant progress in reducing incidence is possible through rigorous domestic vector control and screening of blood and organ donors.[1] Congenital transmission, on the other hand, could perpetuate the existence of Chagas disease indefinitely, even in countries or regions with no or almost no autochthonous vector transmission.[7,8,9,10] This article uses a decision-analytic model to evaluate the societal economic cost of maternal screening to identify and treat infected newborns and their mothers compared with the societal cost of undiagnosed or latediagnosed Chagas disease in the United States

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Results

Discussion

Conclusion