Home Economics American Trypanosomiasis Chagas Disease, Second Edition: One Hundred Years of Research
Program costs and cost-effectiveness of control interventions
The countries of the Southern Cone Initiative have spent in the period 1991—2000 more than US$345 million from their national budgets to finance the vector control activities in their territories since the launching of the Initiative.
The Ministry of Health of Brazil carried out a study aimed at the analysis of the cost-effectiveness and cost—benefit of the Chagas Disease Control Program in Brazil. Due to the chronic nature of the disease and the protracted period of evolution, a period of 21 years was chosen for the analysis. The time interval from 1975
to 1995 includes data from different sources of information that were used to carry out this evaluation.36
Effectiveness was defined using various parameters, but the main one was the measurement of the burden of disease prevented in DALYs (Disability-Adjusted Life Years). From 1975 to 1995, the Program (excluding blood banks) prevented an estimated 89% of potential disease transmission, avoiding some 2,339,000 new infections and 337,000 deaths. This translated into the prevented loss of
11,486,000 DALYs, 31% from averted deaths, and 69% from averted disability, showing the large role of disability in the overall burden of disease caused by Chagas disease.
The estimated benefits (expenditures prevented) of the Program (excluding blood banks) were US$7,500,000,000, 63% of the savings being health-care expenditures and 37% social security expenditures (disability insurance and retirements).
The cost-effectiveness analysis demonstrated that for each US$39 spent on the Program, 1 DALY was gained. This places the Program and its activities in the category of interventions with a very high cost-effectiveness. The results of the cost—benefit analysis indicated savings of US$17 for each dollar spent on prevention, also indicating that the Program is a health investment with good return. The analysis of other diseases with socioeconomic causes demonstrated that the decline in Chagas disease infection rates is due to the preventive activities, and not due to general improvement in life conditions.
The economic impact of the disease during the chronic stage is very high as shown by data from Brazil. If we consider that about 30% of the infected persons will develop severe cardiac and digestive lesions such as cardiac arrhythmia (75,000 cases), mega-esophagus (45,000 cases), and mega-colon (30,000 cases) per year, the estimated costs for pacemaker implants and corrective surgery (average US$5000) would amount to approximately US$750 million per year, which would be enough for the improvement or construction of more than 700,000 rural dwellings at a minimum estimated cost of US$1000 each in Brazil in 2000.
Between 1979 and 1981, 14,022 deaths were due to Chagas disease in Brazil which represented approximately 259,152 years of potential life lost (YPLL) before the age of retirement. Assuming that all the patients were unqualified rural workers only and that the minimum daily wage was at the time US$2.5, the total economic loss due to premature deaths would amount to US$237 million.
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