Echocardiography in Indigenous Populations and Resource Poor Settings.

The majority of global cardiovascular disease burden occurs in low- and middle-income countries (LMIC) and indigenous populations. Although common diseases, such as ischaemic heart disease, cause significant burden, there are also neglected diseases. Forgotten by many, these diseases-including rheumatic heart disease, endomyocardial fibrosis and Chagas cardiomyopathy-continue to take a tremendous toll on a large proportion of the world's population. Whilst the technology of echocardiography continues to evolve in many high-income countries, low resource countries are working out how to make this vital tool available and affordable for the most remote and poorest populations. This paper aims to highlight the neglected cardiovascular diseases and their echocardiographic features. It also highlights the latest research in relation to portable echocardiography, task shifting and disease screening. The authors make recommendations in relation to future directions, including making echocardiography an affordable and accessible tool for all.

Chagas' cardiomyopathy: the economic burden of an expensive and neglected disease.

BACKGROUND: Chagas' cardiomyopathy (CC) is a rising etiology for heart failure (HF) that previously was restricted to some countries of Latin America. The chronic CC cases cause now a profound socio-economic impact. However this issue has not been well studied if compared to other causes of HF. The objective of this study was to assess the cost burden of CC during acute decompensated HF admissions (ADHF), and compare this cost to the other etiologies of HF. METHODS AND RESULTS: By the end of 2006 we started a five year follow-up of 577 consecutive adult patients admitted at a high complexity cardiology university hospital in the city of Sao Paulo, Brazil. This study shows the data of the first admission of each patient of this follow-up. Patients were divided in two groups: CC (58 patients) and non-chagasic (NC) (519 patients). Mortality was different among groups, 19/58 (32.8%) in CC vs 113/519 (21.8%) in NC (p=0.046). The prevalence of signs of inadequate perfusion was higher in the CC group at admission, but in a multivariated analysis chagasic etiology and presence of diabetes were independent predictors of higher costs per day of hospitalization adjusted by mortality. Median costs per day were US$ 308 (277-542) vs US$ 467 (323-815) for NC and CC respectively (p<0.001). CONCLUSION: Treating ADHF patients with CC etiology was more expensive and mortality was higher in this population at the first admission of this follow-up. This could be explained by the severity of Chagas' cardiomyopathy disease.

Global economic burden of Chagas disease: a computational simulation model.

BACKGROUND: As Chagas disease continues to expand beyond tropical and subtropical zones, a growing need exists to better understand its resulting economic burden to help guide stakeholders such as policy makers, funders, and product developers. We developed a Markov simulation model to estimate the global and regional health and economic burden of Chagas disease from the societal perspective. METHODS: Our Markov model structure had a 1 year cycle length and consisted of five states: acute disease, indeterminate disease, cardiomyopathy with or without congestive heart failure, megaviscera, and death. Major model parameter inputs, including the annual probabilities of transitioning from one state to another, and present case estimates for Chagas disease came from various sources, including WHO and other epidemiological and disease-surveillance-based reports. We calculated annual and lifetime health-care costs and disability-adjusted life-years (DALYs) for individuals, countries, and regions. We used a discount rate of 3% to adjust all costs and DALYs to present-day values. FINDINGS: On average, an infected individual incurs US$474 in health-care costs and 0·51 DALYs annually. Over his or her lifetime, an infected individual accrues an average net present value of $3456 and 3·57 DALYs. Globally, the annual burden is $627·46 million in health-care costs and 806,170 DALYs. The global net present value of currently infected individuals is $24·73 billion in health-care costs and 29,385,250 DALYs. Conversion of this burden into costs results in annual per-person costs of $4660 and lifetime per-person costs of $27,684. Global costs are $7·19 billion per year and $188·80 billion per lifetime. More than 10% of these costs emanate from the USA and Canada, where Chagas disease has not been traditionally endemic. A substantial proportion of the burden emerges from lost productivity from cardiovascular disease-induced early mortality. INTERPRETATION: The economic burden of Chagas disease is similar to or exceeds those of other prominent diseases globally (eg, rotavirus $2·0 billion, cervical cancer $4·7 billion) even in the USA (Lyme disease $2·5 billion), where Chagas disease has not been traditionally endemic, suggesting an economic argument for more attention and efforts towards control of Chagas disease. FUNDING: Bill & Melinda Gates Foundation, the National Institute of General Medical Sciences Models of Infectious Disease Agent Study.

[How much does the medical treatment of chronic Chagas cardiopathy cost? Direct costs in a cardiology hospital]. / Cuánto cuesta la atención de la cardiopatía chagásica crónica? Costos directos en un hospital de cardiología.

OBJECTIVE: To estimate health care costs of patients with chronic Chagasic cardiomyopathy (CCC) in a cardiovascular referral center (Instituto Nacional de Cardiología I. Chávez). MATERIAL AND METHODS: In a retrospective study, 13 clinical charts of CCC patients treated in the hospital during 1998 were reviewed. Diagnostic and therapeutic procedures and patients admission were identify as well as health care costs, which were drawn from the hospital costs system. RESULTS: 62% of the cases were admitted to the hospital through the out-patient facilities. All the patients had a health care subsidy of 15 to 55% allocated to the institutional budget. Health care costs were calculated for minimal, average, and maximum scenarios, according to the patient's clinical stage and the price of medical equipment used (low, medium, and high). Most of the health care costs are due to the use of high cost diagnostic equipment (33 a 58%) and hospital stay (including the emergency room) (19 a 28%). CONCLUSION: This is the first approximation to the economic study of Chagas disease in Mexico, providing foundations for further studies on health economics and quality care of CCC, and suggests that prevention should be enhanced.

Cuánto cuesta la atención de la cardiopatía chagásica crónica? Costos directos en un hospital de cardiología / How much does the medical treatment of chronic Chagas cardiopathy cost? Direct costs in a cardiology hospital

OBJECTIVE: To estimate health care costs of patients with chronic Chagasic cardiomyopathy (CCC) in a cardiovascular referral center (Instituto Nacional de CardiologÝa I. Chßvez). MATERIAL AND METHODS: In a retrospective study, 13 clinical charts of CCC patients treated in the hospital during 1998 were reviewed. Diagnostic and therapeutic procedures and patients admission were identify as well as health care costs, which were drawn from the hospital costs system. RESULTS: 62 of the cases were admitted to the hospital through the out-patient facilities. All the patients had a health care subsidy of 15 to 55 allocated to the institutional budget. Health care costs were calculated for minimal, average, and maximum scenarios, according to the patient's clinical stage and the price of medical equipment used (low, medium, and high). Most of the health care costs are due to the use of high cost diagnostic equipment (33 a 58) and hospital stay (including the emergency room) (19 a 28). CONCLUSION: This is the first approximation to the economic study of Chagas disease in Mexico, providing foundations for further studies on health economics and quality care of CCC, and suggests that prevention should be enhanced.

Infección humana por trypanosoma cruzi en Chile: algunas estimaciones epidemiológicas y de los costos de la atención y tratamiento del paciente chagásico / Trypanosoma cruzi human infection in Chile: some estimates on epidemiology and care and treatment costs of the chagasic patient

According to the gathered information from the 1992 Chile census and an extensive epidemiological field study of Chagasïdisease in rural-periurban sections of the seven most northern regions where this malady is endemic, the following epidemiological outline arises: Total population in the country 13,348,401. Population in endemic regions 8,824,205 (urban 8,050,700 rural 773,505). Number of infected 142,000 (16,7 percent). Total number of cardiopathies 26,554 (18,7 percent). In considering the regime of fees for health attentions of the National Health Funds- including hospitalization, laboratory test and surgical interventions- in its minimal prices plus the value of medicaments, it is posible to produce some estimates onf the cost of attention and treatment, in U.S. dollars, of the chagasic patient. Average annual cost of a patient with chronic chagasic cardiopathy U.S.$ 439,29 to U.S.$ 584,25 If these values are multiplied by 26,554 give rise to a figure ranging from U.S.$ 11,644,906 to U.S.$ 15,514,474