The costs of preventing and treating chagas disease in Colombia.
BACKGROUND
The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy.


METHODS
Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation.


RESULTS
The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between $46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is $1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care.


CONCLUSIONS
Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.
Castillo-Riquelme
Marianela
M
Health Economic and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. marianelacastillo@hotmail.com
Guhl
Felipe
F
Turriago
Brenda
B
Pinto
Nestor
N
Rosas
Fernando
F
Martínez
Mónica Flórez
MF
Fox-Rushby
Julia
J
Davies
Clive
C
Campbell-Lendrum
Diarmid
D
D000818:Animals; D014355:Chagas Disease / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D003105:Colombia / Q000453:epidemiology; D003140:Communicable Disease Control / Q000191:economics; D003365:Costs and Cost Analysis; D004199:Disease Vectors; D004478:Ectoparasitic Infestations / Q000191:economics / Q000517:prevention & control; D006798:Housing / Q000191:economics; D006801:Humans; D012189:Retrospective Studies; D012424:Rural Population; D014349:Trypanosoma cruzi