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

Abstract

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.

Estimating the current burden of Chagas disease in Mexico: A systematic review and meta-analysis of epidemiological surveys from 2006 to 2017

“…Indeed, a recent health economic study in the US evidenced the large benefits of maternal screening for T . cruzi infection, as lifetime societal savings due to screening and treatment was estimated at $634 million saved for every birth year cohort [64].…”

Chagas Disease in the United States: a Public Health Approach

“…Ten (0.25%) women had confirmed T. cruzi infection; no infected infants were detected. A recent analysis concluded that in the United States, universal congenital Chagas disease screening and treatment would be cost-saving with congenital transmission rates > 0.001% and maternal prevalence >0.06% (339). The results vary substantially depending on the cost and performance of the maternal screening test; thus, it will be essential to ascertain the currently unknown sensitivity of available serological assays in at-risk populations in the United States.…”

WHF IASC Roadmap on Chagas Disease

“…Healthcare personnel are often unfamiliar with the risk of congenital transmission [52]. Screening of pregnant women is far from universal, and totally absent in some affected countries [53,54,55], despite the demonstrated cost-effectiveness of these programmes in both endemic and non-endemic settings [53,55,56]. The regional initiative Eliminating Mother to Child Transmission Plus, launched by PAHO in 2017 [57], works to strengthen health systems in participating countries to interrupt congenital transmission of CD along with other congenitally transmitted infectious diseases, although the recommendations in this document are far from being widely adopted in the region.…”