RESUMEN
Objetivo: Caracterizar o perfil sociodemográfico de beneficiários da seguridade social brasileira com doença de Chagas e identificar fatores associados à concessão de benefícios assistenciais, 2004-2016. Métodos: Estudo transversal, com dados secundários do Ministério do Trabalho e Previdência Social. Empregou-se regressão logística para estimar as razões de chances (OR: odds ratios), brutas e ajustadas, e intervalos de confiança de 95% (IC95%). Resultados: Foram concedidos 36.023 benefícios: 62,5% a pessoas do sexo masculino; 67,0% para residentes de áreas urbanas; 46,7% para moradores da macrorregião Sudeste; 56,7% para pessoas com forma cardíaca crônica; e 42,7% para a faixa etária de 50-59 anos. Residir em áreas urbanas (OR = 134,9; IC95% 78,0;233,2), residir no Nordeste (OR = 2,9; IC95% 2,5;3,1), ser do sexo feminino (OR = 2,0; IC95% 1,8;2,1) e ter idade de 60 anos ou mais (OR = 1,6; IC95% 1,3;1,7) estiveram associados aos benefícios assistenciais. Conclusão: Fatores relacionados a zona de residência, macrorregião, sexo e faixa etária aumentaram a chance de concessão de benefícios assistenciais.
Objetivo: Caracterizar el perfil sociodemográfico de los beneficiarios de la seguridad social brasileña con enfermedad de Chagas e identificar los factores asociados a la concesión de beneficios asistenciales, de 2004 a 2016. Métodos: Estudio transversal con datos del Ministerio de Trabajo y Seguridad Social. Se utilizó la regresión logística para estimar las razones de probabilidad (OR) brutas y ajustadas. Resultados: Se otorgaron 36.023 beneficios; 62,5% para el sexo masculino; 67,0% para residentes en áreas urbanas; 46,7% residentes del Sudeste; 56,7% para personas con insuficiencia cardiaca crónica; y 42,7% para personas de 50-59 años. Residir en áreas urbanas (OR = 134,9; IC95% 78,0;233,2), en el Nordeste (OR = 2,9; IC95% 2,5;3,1), ser de sexo femenino (OR = 2,0; IC95% 1,8;2,1) y tener de 60 años o más (OR = 1,6; IC95% 1,3;1,7) fueron factores asociados a las prestaciones asistenciales. Conclusión: Los factores relacionados con el local de residencia, sexo y grupo de edad aumentaron la posibilidad de otorgar beneficios asistenciales.
Objective: To characterize the sociodemographic profile of beneficiaries of Brazilian social welfare affected by Chagas disease and identify factors associated with the granting of assistance benefits, 2004 to 2016. Methods: Cross-sectional study based on secondary data from the Ministry of Labor and Social Security. Logistical regression was performed to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI). Results: 36,023 benefits were granted; 62.5% were to male; 67.0% to residents of urban areas; 46.7% to residents of Southeast region; 56.7% to people with chronic cardiac form; and 42.7% to the 50-59 age group. Residents of urban areas (OR = 134.9; 95%CI 78.0;233.2), Northeast macro-region (OR = 2.9; 95%CI 2.5;3.1), female (OR = 2.0; 95%CI 1.8;2.1) and age group 60 years or older (OR = 1.6; 95%CI 1,3;1,7) were factors associated with assistance benefits. Conclusion: Factors related to the area of residence, macro-region, sex and age group increased the chance of granting assistance benefits.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Bienestar Social , Enfermedad de Chagas/economía , Determinantes Sociales de la Salud , Seguridad Social , Brasil , Estudios TransversalesRESUMEN
BACKGROUND: Chagas disease (CD) is highly endemic in the Bolivian Chaco. The municipality of Monteagudo has been targeted by national interventions as well as by Médecins Sans Frontières to reduce infection rates, and to decentralize early diagnosis and treatment. This study seeks to determine the knowledge and attitudes of a population with increased awareness and to identify remaining factors and barriers for sustained vector control, health care seeking behaviour, and access, in order to improve future interventions. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among approximately 10% (n = 669) of the municipality of Monteagudo's households that were randomly selected. Additionally, a total of 14 in-depth interviews and 2 focus group discussions were conducted with patients and key informants. Several attitudes and practices were identified that could undermine effective control against (re-)infection. Knowledge of clinical symptoms and secondary prevention was limited, and revealed specific misconceptions. Although 76% of the participants had been tested for CD, only 18% of those who tested positive concluded treatment with benznidazole (BNZ). Sustained positive serologies after treatment led to perceived ineffectiveness of BNZ. Moreover, access barriers such as direct as well as indirect costs, BNZ stock-outs and a fear of adverse reactions triggered by other community members made patients opt for alternative treatments against CD such as veterinary ivermectin, used by 28% of infected participants in our study. The lack of accessible care for chronic complications as well as socioeconomic consequences, such as the exclusion from both job opportunities and bank loans contributed to the ongoing burden of CD. CONCLUSIONS/SIGNIFICANCE: Large scale interventions should be accompanied by operational research in order to identify misconceptions and unintended consequences early on, to generate accessible data for future interventions, and for rigorous evaluation. An integrated, community-based approach tackling social determinants and including both traditional and animal health sectors might help to overcome current barriers and advocate for patients' rights.
Asunto(s)
Enfermedad de Chagas/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Nitroimidazoles/uso terapéutico , Aceptación de la Atención de Salud/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bolivia/epidemiología , Enfermedad de Chagas/economía , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/prevención & control , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nitroimidazoles/economía , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
TRIAL REGISTRATION: NCT02646943.
Asunto(s)
Enfermedad de Chagas/psicología , Calidad de Vida , Adulto , Anciano , Brasil/epidemiología , Enfermedad de Chagas/economía , Enfermedad de Chagas/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores SocioeconómicosRESUMEN
OBJECTIVE: To quantify the costs of Chagas disease in Colombia from a societal perspective in 2017. METHODS: A cost-of-illness analysis was carried out using a prevalence-based approach. Costs attributable to Chagas were estimated from a bottom-up strategy, using population attributable fractions. Indirect costs were calculated using the human capital approach. RESULTS: The estimated total cost of diagnosed Chagas disease was US $13.1 million and included $5.7 million in direct medical costs, $1.5 million in direct nonmedical costs, and $5.8 million in indirect costs: absenteeism ($2.2 million), presenteeism ($3.1 million), and premature deaths ($515228). On average, people diagnosed with Chagas disease incurred $594 in medical expenses, and more than half of that expense was directly attributable to Chagas. The annual cost to society for a person with chronic Chagas disease was $4226. CONCLUSIONS: Chagas disease imposes a substantial financial burden on healthcare system and society. Economic cost of illness-related productivity losses is much more significant. Our research suggests that a health policy framework addressing as many of the social determinants of health as possible may be pivotal in containing social costs. Therefore, reducing this burden is not only the responsibility of the health system.
Asunto(s)
Enfermedad de Chagas/economía , Absentismo , Adolescente , Adulto , Anciano , Colombia , Costo de Enfermedad , Eficiencia , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Therapeutic vaccines to prevent Chagas disease progression to cardiomyopathy are under development because the only available medications (benznidazole and nifurtimox) are limited by their efficacy, long treatment course, and side effects. Better understanding the potential clinical and economic value of such vaccines can help guide development and implementation. METHODS: We developed a computational Chagas Markov model to evaluate the clinical and economic value of a therapeutic vaccine given in conjunction with benznidazole in indeterminate and chronic Chagas patients. Scenarios explored the vaccine's impact on reducing drug treatment dosage, duration, and adverse events, and risk of disease progression. RESULTS: When administering standard-of-care benznidazole to 1000 indeterminate patients, 148 discontinued treatment and 219 progressed to chronic disease, resulting in 119 Chagas-related deaths and 2293 DALYs, costing $18.9 million in lifetime societal costs. Compared to benznidazole-only, therapeutic vaccination administered with benznidazole (25-75% reduction in standard dose and duration), resulted in 37-111 more patients (of 1000) completing treatment, preventing 11-219 patients from progressing, 6-120 deaths, and 108-2229 DALYs (5-100% progression risk reduction), saving ≤$16,171 per patient. When vaccinating determinate Kuschnir class 1 Chagas patients, 10-197 fewer patients further progressed compared to benznidazole-only, averting 11-228 deaths and 144-3037 DALYs (5-100% progression risk reduction), saving ≤$34,059 per person. When vaccinating Kuschnir class 2 patients, 13-279 fewer progressed (279 with benznidazole-only), averting 13-692 deaths and 283-10,785 DALYs (5-100% progression risk reduction), saving ≤$89,759. Therapeutic vaccination was dominant (saved costs and provided health benefits) with ≥â¯5% progression risk reduction, except when only reducing drug treatment regimen and adverse events, but remained cost-effective when costing <$200. CONCLUSIONS: Our study helps outline the thresholds at which a therapeutic Chagas vaccine may be cost-effective (e.g., <5% reduction in preventing cardiac progression, 25% reduction in benznidazole treatment doses and duration) and cost-saving (e.g., ≥5% and 25%, respectively).
Asunto(s)
Cardiomiopatías/economía , Cardiomiopatías/inmunología , Enfermedad de Chagas/economía , Enfermedad de Chagas/inmunología , Vacunas/economía , Vacunas/inmunología , Enfermedad Crónica/economía , Enfermedad Crónica/prevención & control , Análisis Costo-Beneficio/economía , Progresión de la Enfermedad , Humanos , Nitroimidazoles/uso terapéutico , Trypanosoma cruzi/inmunología , Vacunación/economíaRESUMEN
BACKGROUND: The World Health Organization's 2020 Goals for Chagas disease include access to antiparasitic treatment and care of all infected/ill patients. Policy makers need to know the economic value of identifying and treating patients earlier. However, the economic value of earlier treatment to cure and prevent the Chagas' spread remains unknown. METHODS: We expanded our existing Chagas disease transmission model to include identification and treatment of Chagas disease patients. We linked this to a clinical and economic model that translated chronic Chagas disease cases into health and economic outcomes. We evaluated the impact and economic outcomes (costs, cost-effectiveness, cost-benefit) of identifying and treating different percentages of patients in the acute and indeterminate disease states in a 2,000-person village in Yucatan, Mexico. RESULTS: In the absence of early treatment, 50 acute and 22 new chronic cases occurred over 50 years. Identifying and treating patients in the acute stage averted 0.5-5.4 acute cases, 0.6-5.5 chronic cases, and 0.6-10.8 disability-adjusted life years (DALYs), saving $694-$7,419 and $6,976-$79,950 from the third-party payer and societal perspectives, respectively. Treating in the indeterminate stage averted 2.2-4.9 acute cases, 6.1-12.8 chronic cases, and 11.7-31.1 DALYs, saving $7,666-$21,938 from the third-party payer perspective and $90,530-$243,068 from the societal perspective. Treating patients in both stages averted ≤9 acute cases and ≤15 chronic cases. Identifying and treating patients early was always economically dominant compared to no treatment. Identifying and treating patients earlier resulted in a cumulative cost-benefit of $7,273-$224,981 at the current cost of identification and treatment. CONCLUSIONS: Even when identifying and treating as little as 5% of cases annually, treating Chagas cases in the acute and indeterminate stages reduces transmission and provides economic and health benefits. This supports the need for improved diagnostics and access to safe and effective treatment.
Asunto(s)
Antiprotozoarios/economía , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/economía , Prevención Secundaria/economía , Animales , Antiprotozoarios/uso terapéutico , Enfermedad de Chagas/parasitología , Enfermedad de Chagas/transmisión , Análisis Costo-Beneficio , Humanos , México , Resultado del Tratamiento , Trypanosoma cruzi/efectos de los fármacos , Trypanosoma cruzi/fisiologíaRESUMEN
Insecticide spraying of housing units is an important control measure for vector-borne infections such as Chagas disease. As vectors may invade both from other infested houses and sylvatic areas and as the effectiveness of insecticide wears off over time, the dynamics of (re)infestations can be approximated by [Formula: see text]-type models with a reservoir, where housing units are treated as hosts, and insecticide spraying corresponds to removal of hosts. Here, we investigate three ODE-based models of this type. We describe a dual-rate effect where an initially very high spraying rate can push the system into a region of the state space with low endemic levels of infestation that can be maintained in the long run at relatively moderate cost, while in the absence of an aggressive initial intervention the same average cost would only allow a much less significant reduction in long-term infestation levels. We determine some sufficient and some necessary conditions under which this effect occurs and show that it is robust in models that incorporate some heterogeneity in the relevant properties of housing units.
Asunto(s)
Control de Insectos/economía , Control de Insectos/métodos , Insectos Vectores , Modelos Biológicos , Animales , Enfermedad de Chagas/economía , Enfermedad de Chagas/prevención & control , Costos y Análisis de Costo , Vivienda , Humanos , Insecticidas/administración & dosificación , Insecticidas/economía , Conceptos Matemáticos , Modelos EconómicosRESUMEN
After more than one century since its discovery, Chagas disease is still extremely prevalent in 21 Latin American countries. Chagas disease is one of the most concerning public health problems in Latin America; the overall cost of CD treatment is approximately 7 billion United States dollars per year and it has a strong social impact on populations. Little progress has been made regarding the access to diagnosis and treatment at the primary health care level, calling into question the current policies to ensure the right to health and access to essential medications. In this article, diverse dimensions of access to treatment for Chagas disease are reviewed, illustrating the present state of benznidazole medication in relation to global production capacity, costs, and needs. The findings are based on an investigation requested by Médecins Sans Frontières Brazil through a consultancy in 2015, aiming to estimate the current costs of benznidazole production.
Asunto(s)
Enfermedad de Chagas/tratamiento farmacológico , Costos de los Medicamentos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Brasil , Enfermedad de Chagas/economía , Necesidades y Demandas de Servicios de Salud , Humanos , América Latina , Nitroimidazoles/economía , Tripanocidas/economíaRESUMEN
Abstract After more than one century since its discovery, Chagas disease is still extremely prevalent in 21 Latin American countries. Chagas disease is one of the most concerning public health problems in Latin America; the overall cost of CD treatment is approximately 7 billion United States dollars per year and it has a strong social impact on populations. Little progress has been made regarding the access to diagnosis and treatment at the primary health care level, calling into question the current policies to ensure the right to health and access to essential medications. In this article, diverse dimensions of access to treatment for Chagas disease are reviewed, illustrating the present state of benznidazole medication in relation to global production capacity, costs, and needs. The findings are based on an investigation requested by Médecins Sans Frontières Brazil through a consultancy in 2015, aiming to estimate the current costs of benznidazole production.
Asunto(s)
Humanos , Tripanocidas/uso terapéutico , Costos de los Medicamentos/estadística & datos numéricos , Enfermedad de Chagas/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Nitroimidazoles/uso terapéutico , Tripanocidas/economía , Brasil , Enfermedad de Chagas/economía , Necesidades y Demandas de Servicios de Salud , América Latina , Nitroimidazoles/economíaRESUMEN
BACKGROUND: Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the Latin American population attending primary care centres in Europe. METHODS: We constructed a decision tree model that compared the test option (screening of asymptomatic individuals, treatment, and follow-up of positive cases) with the no-test option (screening, treating, and follow-up of symptomatic individuals). The decision tree included a Markov model with five states, related to the chronic stage of the disease: indeterminate, cardiomyopathy, gastrointestinal, response to treatment, and death. The model started with a target population of 100â000 individuals, of which 4·2% (95% CI 2·2-6·8) were estimated to be infected by Trypanosoma cruzi. The primary outcome was the incremental cost-effectiveness ratio (ICER) between test and no-test options. Deterministic and probabilistic analyses (Monte Carlo simulations) were performed. FINDINGS: In the deterministic analysis, total costs referred to 100â000 individuals in the test and no-test option were 30â903â406 and 6â597â403 respectively, with a difference of 24â306â003. The respective number of quality-adjusted life-years (QALYs) gained in the test and no-test option were 61â820·82 and 57â354·42. The ICER was 5442. In the probabilistic analysis, total costs for the test and no-test option were 32â163â649 (95% CI 31â263â705-33â063â593) and 6â904â764 (6â703â258-7â106â270), respectively. The respective number of QALYs gained was 64â634·35 (95% CI 62â809·6-66â459·1) and 59â875·73 (58â191·18-61â560·28). The difference in QALYs gained between the test and no test options was 4758·62 (95% CI 4618·42-4898·82). The incremental cost-effectiveness ratio (ICER) was 6840·75 (95% CI 2545-2759) per QALY gained for a treatment efficacy of 20% and 4243 per QALY gained for treatment efficacy of 50%. Even with a reduction in Chagas disease prevalence to 0·05% and with large variations in all the parameters, the test option would still be more cost-effective than the no-test option (less than 30000 per QALY). INTERPRETATION: Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a cost-effective strategy. Findings of our model provide an important element to support the implementation of T cruzi screening programmes at primary health centres in European countries hosting Latin American migrants. FUNDING: European Commission 7th Framework Program.
Asunto(s)
Enfermedad de Chagas/economía , Enfermedad de Chagas/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Tamizaje Masivo/economía , Atención Primaria de Salud/economía , Antiprotozoarios/economía , Enfermedad de Chagas/diagnóstico , Análisis Costo-Beneficio , Europa (Continente)/epidemiología , Femenino , Humanos , América Latina/etnología , Masculino , Tamizaje Masivo/estadística & datos numéricos , Atención Primaria de Salud/organización & administraciónAsunto(s)
Enfermedad de Chagas/parasitología , Enfermedad de Chagas/transmisión , Parasitología de Alimentos , Enfermedades Transmitidas por los Alimentos/parasitología , Trypanosoma cruzi/fisiología , Enfermedad de Chagas/economía , Enfermedad de Chagas/epidemiología , Frío , Culinaria , Almacenamiento de Alimentos , Salud Global/economía , Salud Global/tendencias , Humanos , Internacionalidad , Enfermedades DesatendidasRESUMEN
Although Spain is the European country with the highest Chagas disease burden, the country does not have a national control program of the disease. The purpose of this study is to evaluate the efficiency of several strategies for Chagas disease screening among Latin American residents living in Spain. The following screening strategies were evaluated: (1) non-screening; (2) screening of the Latin American pregnant women and their newborns; (3) screening also the relatives of the positive pregnant women; (4) screening also the relatives of the negative pregnant women. A cost-utility analysis was carried out to compare the four strategies from two perspectives, the societal and the Spanish National Health System (SNHS). A decision tree representing the clinical evolution of Chagas disease throughout patient's life was built. The strategies were compared through the incremental cost-utility ratio, using euros as cost measurement and quality-adjusted life years as utility measurement. A sensitivity analysis was performed to test the model parameters and their influence on the results. We found the "Non-screening" as the most expensive and less effective of the evaluated strategies, from both the societal and the SNHS perspectives. Among the screening evaluated strategies the most efficient was, from both perspectives, to extent the antenatal screening of the Latin American pregnant women and their newborns up to the relatives of the positive women. Several parameters influenced significantly on the sensitivity analyses, particularly the chronic treatment efficacy or the prevalence of Chagas disease. In conclusion, for the general Latin American immigrants living in Spain the most efficient would be to screen the Latin American mothers, their newborns and the close relatives of the mothers with a positive serology. However for higher prevalence immigrant population the most efficient intervention would be to extend the program to the close relatives of the negative mothers.
Asunto(s)
Enfermedad de Chagas/economía , Emigrantes e Inmigrantes , Tamizaje Masivo/economía , Complicaciones Parasitarias del Embarazo/economía , Tripanocidas/economía , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/epidemiología , Análisis Costo-Beneficio , Europa (Continente) , Femenino , Humanos , Recién Nacido , América Latina/etnología , Masculino , Embarazo , Complicaciones Parasitarias del Embarazo/diagnóstico , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Complicaciones Parasitarias del Embarazo/epidemiología , Prevalencia , Años de Vida Ajustados por Calidad de Vida , España/epidemiología , Tripanocidas/uso terapéuticoRESUMEN
As an evaluation scheme, we propose certifying for "control", as alternative to "interruption", of Chagas disease transmission by native vectors, to project a more achievable and measurable goal and sharing good practices through an "open online platform" rather than "formal certification" to make the key knowledge more accumulable and accessible.
Asunto(s)
Certificación/organización & administración , Enfermedad de Chagas/prevención & control , Insectos Vectores/metabolismo , Triatoma/metabolismo , Logro , Animales , América Central , Enfermedad de Chagas/economía , Enfermedad de Chagas/transmisión , Humanos , InsecticidasRESUMEN
As an evaluation scheme, we propose certifying for “control”, as alternative to “interruption”, of Chagas disease transmission by native vectors, to project a more achievable and measurable goal and sharing good practices through an “open online platform” rather than “formal certification” to make the key knowledge more accumulable and accessible.
Asunto(s)
Animales , Humanos , Certificación/organización & administración , Enfermedad de Chagas/prevención & control , Insectos Vectores/metabolismo , Triatoma/metabolismo , Logro , América Central , Enfermedad de Chagas/economía , Enfermedad de Chagas/transmisión , InsecticidasRESUMEN
BACKGROUND: Given current neglect for Chagas disease in public health programs in Mexico, future healthcare and economic development policies will need a more robust model to analyze costs and impacts of timely clinical attention of infected populations. METHODOLOGY/PRINCIPAL FINDINGS: A Markov decision model was constructed to simulate the natural history of a Chagas disease cohort in Mexico and to project the associated short and long-term clinical outcomes and corresponding costs. The lifetime cost for a timely diagnosed and treated Chagas disease patient is US$ 10,160, while the cost for an undiagnosed individual is US$ 11,877. The cost of a diagnosed and treated case increases 24-fold from early acute to indeterminate stage. The major cost component for lifetime cost was working days lost, between 44% and 75%, depending on the program scenario for timely diagnosis and treatment. CONCLUSIONS/SIGNIFICANCE: In the long term, it is cheaper to diagnose and treat chagasic patients early, instead of doing nothing. This finding by itself argues for the need to shift current policy, in order to prioritize and attend this neglected disease for the benefit of social and economic development, which implies including treatment drugs in the national formularies. Present results are even more relevant, if one considers that timely diagnosis and treatment can arrest clinical progression and enhance a chronic patient's quality of life.