Cost-Effectiveness of Blood Donation Screening for Trypanosoma cruzi in Mexico

Abstract

An estimated 2 million inhabitants are infected with Chagas disease in Mexico, with highest prevalence coinciding with highest demographic density in the southern half of the country. After vector-borne transmission, Trypanosoma cruzi is principally transmitted to humans via blood transfusion. Despite initiation of serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. Most recent regulatory changes and segmented blood services in Mexico may affect compliance of mandatory screening guidelines. The objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare and regular salaried worker health service institutions: the Secretary of Health and the Mexican Institute for Social Security. We developed a bi-modular model to analyze compliance using a decision tree for the most common screening algorithms for each health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health, while the cost for an additional life-year gained is US$ 463 for the Social Security Institute. The results of the present study suggest that due to incomplete compliance of Mexico’s national legislation during 2013 and 2014, the MoH has failed to confirm 15,162 T. cruzi infections, has not prevented 2,347 avoidable infections, and has lost 333,483 life-years. Although there is a vast difference in T. cruzi prevalence between Bolivia and Mexico, Bolivia established mandatory blood screening for T.cruzi in 1996 and until 2002 detected and discarded 11,489 T. cruzi -infected blood units and prevented 2,879 potential infections with their transfusion blood screening program. In the first two years of Mexico’s mandated program, the two primary institutions failed to prevent due to incomplete compliance more potential infections than those gained from the first five years of Bolivia’s program. Full regulatory compliance should be clearly understood as mandatory for the sake of blood security, and its monitoring and analysis in Mexico should be part of the health authority’s responsibility.

Seroprevalence and geographical distribution of sero‐positive blood donors to Trypanosoma cruzi at the central blood bank of the National Medical Center “La Raza”

“…Although the main route of T. cruzi infection is through the vector's bite, blood transfusion has been identified as an alternate route of infection, thereby increasing the risk of transmission via the transfusion from infected blood of people migrating from endemic to non‐endemic areas . In order to mitigate the spread of Chagas disease through blood transfusion, governments have put in place several policies and regulations to manage the process of blood donation and reduce the risk of disease transmission .…”

Impact of climate change on vector transmission of Trypanosoma cruzi (Chagas, 1909) in North America

“…Yet, the only CD prevention activity in Mexico, with minor exceptions (i.e. isolated efforts towards vector control in rural communities), is T. cruzi blood transfusion screening (CENAPRECE, ; Sánchez‐González et al ., ). This screening provides the only source of population‐based prevalence estimates for the country, although they require adjustment as there are two urban donors for every rural donor, on average (Trujillo‐Contreras et al ., ; Sánchez‐González et al ., ).…”

“…isolated efforts towards vector control in rural communities), is T. cruzi blood transfusion screening (CENAPRECE, ; Sánchez‐González et al ., ). This screening provides the only source of population‐based prevalence estimates for the country, although they require adjustment as there are two urban donors for every rural donor, on average (Trujillo‐Contreras et al ., ; Sánchez‐González et al ., ). Trypanosoma cruzi transmission by blood transfusion in the U.S.A. has been reported for several decades (Leiby et al ., , ), whereas house infestation by vectors and vector‐borne T. cruzi transmission to human populations have been documented only recently in some states of the southern U.S.A. (Beard et al ., ; Lambert et al ., ), and are completely unknown in the other states (Lambert et al ., ; Sarkar et al ., ).…”

Are the London Declaration’s 2020 goals sufficient to control Chagas disease?: Modeling scenarios for the Yucatan Peninsula

“…Despite having one of the greatest burdens of Chagas disease worldwide, Mexico has not yet undertaken a national vector control program[ 4 ] and only started mandatory serological screening in 2012[ 17 ]. In 2010, approximately an estimated 876,458 people were infected and 23.5 million were at risk for infection[ 22 ], with 88% of the population potentially exposed to at least one competent vector species[ 23 ].…”

“…Additionally, low attendance to perinatal care can hinder adequate diagnosis and treatment[ 16 ] of pregnant women and infants, and compliance with universal screening of blood donors is not always 100%. [ 17 ] Furthermore, Chagas policies may be thwarted by decentralization (i.e., movement of authority from a central to a local government). [ 1 , 18 ] Therefore, knowing the impact of partially achieving the goals to varying degrees would be helpful.…”