Abstract
BackgroundChagas disease, caused by the parasite Trypanosoma cruzi (T. cruzi), is the leading etiology of non-ischemic heart disease worldwide, with Latin America bearing the majority of the burden. This substantial burden and the limitations of current interventions have motivated efforts to develop a vaccine against T. cruzi.Methodology/Principal FindingsWe constructed a decision analytic Markov computer simulation model to assess the potential economic value of a T. cruzi vaccine in Latin America from the societal perspective. Each simulation run calculated the incremental cost-effectiveness ratio (ICER), or the cost per disability-adjusted life year (DALY) avoided, of vaccination. Sensitivity analyses evaluated the impact of varying key model parameters such as vaccine cost (range: $0.50–$200), vaccine efficacy (range: 25%–75%), the cost of acute-phase drug treatment (range: $10–$150 to account for variations in acute-phase treatment regimens), and risk of infection (range: 1%–20%). Additional analyses determined the incremental cost of vaccinating an individual and the cost per averted congestive heart failure case. Vaccination was considered highly cost-effective when the ICER was ≤1 times the GDP/capita, still cost-effective when the ICER was between 1 and 3 times the GDP/capita, and not cost-effective when the ICER was >3 times the GDP/capita. Our results showed vaccination to be very cost-effective and often economically dominant (i.e., saving costs as well providing health benefits) for a wide range of scenarios, e.g., even when risk of infection was as low as 1% and vaccine efficacy was as low as 25%. Vaccinating an individual could likely provide net cost savings that rise substantially as risk of infection or vaccine efficacy increase.Conclusions/SignificanceResults indicate that a T. cruzi vaccine could provide substantial economic benefit, depending on the cost of the vaccine, and support continued efforts to develop a human vaccine.
Highlights
Chagas disease (American trypanosomiasis), caused by the parasite Trypanosoma cruzi (T. cruzi), is a leading etiology of nonischemic heart disease worldwide [1] and has a substantial impact on Latin America, resulting in an estimated 750,000 productive life years lost and 1.2 billion dollars lost annually [2,3,4]
We developed a computational economic model to determine the costeffectiveness of introducing a T. cruzi vaccine in Latin America
We developed a computer model to evaluate the economic value of a T. cruzi vaccine for the control of Chagas disease in Latin America
Summary
Chagas disease (American trypanosomiasis), caused by the parasite Trypanosoma cruzi (T. cruzi), is a leading etiology of nonischemic heart disease worldwide [1] and has a substantial impact on Latin America, resulting in an estimated 750,000 productive life years lost and 1.2 billion dollars lost annually [2,3,4]. While acute disease is primarily asymptomatic, cases often transition to the chronic phase and clinically manifest as cardiomyopathy and subsequent congestive heart failure (CHF) decades after infection [1,5,6]. Those who develop Chagas-related CHF have poorer prognoses and higher mortality rates than those with other CHF etiologies [2]. Chagas disease, caused by the parasite Trypanosoma cruzi (T. cruzi), is the leading etiology of non-ischemic heart disease worldwide, with Latin America bearing the majority of the burden This substantial burden and the limitations of current interventions have motivated efforts to develop a vaccine against T. cruzi
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