title: The potential economic value of a Trypanosoma cruzi (Chagas disease) vaccine in Latin America.
abstract: BACKGROUND
  Chagas disease, caused by the parasite Trypanosoma cruzi (T. cruzi), is the leading etiology of non-ischemic heart disease worldwide, with Latin America bearing the majority of the burden. This substantial burden and the limitations of current interventions have motivated efforts to develop a vaccine against T. cruzi.
  
  
  RESULTS
  We constructed a decision analytic Markov computer simulation model to assess the potential economic value of a T. cruzi vaccine in Latin America from the societal perspective. Each simulation run calculated the incremental cost-effectiveness ratio (ICER), or the cost per disability-adjusted life year (DALY) avoided, of vaccination. Sensitivity analyses evaluated the impact of varying key model parameters such as vaccine cost (range: $0.50-$200), vaccine efficacy (range: 25%-75%), the cost of acute-phase drug treatment (range: $10-$150 to account for variations in acute-phase treatment regimens), and risk of infection (range: 1%-20%). Additional analyses determined the incremental cost of vaccinating an individual and the cost per averted congestive heart failure case. Vaccination was considered highly cost-effective when the ICER was ≤1 times the GDP/capita, still cost-effective when the ICER was between 1 and 3 times the GDP/capita, and not cost-effective when the ICER was >3 times the GDP/capita. Our results showed vaccination to be very cost-effective and often economically dominant (i.e., saving costs as well providing health benefits) for a wide range of scenarios, e.g., even when risk of infection was as low as 1% and vaccine efficacy was as low as 25%. Vaccinating an individual could likely provide net cost savings that rise substantially as risk of infection or vaccine efficacy increase.
  
  
  CONCLUSIONS
  Results indicate that a T. cruzi vaccine could provide substantial economic benefit, depending on the cost of the vaccine, and support continued efforts to develop a human vaccine.
authors.affiliation: Public Health Computational and Operations Research, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. BYL1@pitt.edu
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Bacon
authors.forename: Diana L
authors.initials: DL
authors.lastname: Connor
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Willig
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014355:Chagas Disease / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008875:Middle Aged; D015233:Models, Statistical; D016052:Protozoan Vaccines / Q000191:economics* / Q000276:immunology*; D014349:Trypanosoma cruzi / Q000276:immunology*; D055815:Young Adult
chemical_list: D016052:Protozoan Vaccines