The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission

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. Author summary: 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 and what can be invested. We evaluated the impact and economic outcomes (costs, cost-effectiveness, cost-benefit) of identifying and treating different percentages of Chagas patients in the acute and indeterminate disease states using a transmission model linked to a clinical and economic outcomes model. Identifying and treating Chagas cases in the acute and indeterminate stages could result in up to an 18.0% relative reduction in transmission events as well as a 68.2% relative reduction in new chronic cases over 50 years compared to no treatment and was always economically dominant compared to no treatment. Identifying and treating Chagas disease in its earlier stages would reduce transmission and result in better health outcomes and cost-savings. In fact, the cost-savings would outweigh the cost of treating, meaning that earlier treatment may pay for itself. This supports the need for improved diagnostics and access to effective treatment.