Economic evaluation of Chagas disease screening in Spain.
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.
Spanish Health Technology Assessment Agency, Instituto de Salud Carlos III, REDISSEC, Spanish Research Network on Chronic Diseases Health Services, Madrid, Spain. Electronic address: imaz@isciii.es.
Iñaki
I
Imaz-Iglesia
Department of Preventive Medicine, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: lucigasan@hotmail.com.
Lucía García-San
LG
Miguel
Department of Preventive Medicine, Hospital Clínico Universitario San Carlos, Madrid, Spain. Electronic address: leam29@gmail.com.
L Eduardo
LE
Ayala-Morillas
Health Assessment Department, Canary Islands Health Agency, Canary Foundation for Health Research, REDISSEC, Spanish Research Network on Chronic Diseases Health Services, Canary Islands, Spain. Electronic address: lidia.garciaperez@sescs.es.
Lidia
L
García-Pérez
Spanish Health Technology Assessment Agency, Instituto de Salud Carlos III, REDISSEC, Spanish Research Network on Chronic Diseases Health Services, Madrid, Spain. Electronic address: jgonza@isciii.es.
Jesús
J
González-Enríquez
National Centre for Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: tblasco@isciii.es.
Teresa
T
Blasco-Hernández
Department of Preventive Medicine, Hospital Universitario La Princesa, Madrid, Spain. Electronic address: bmartinagueda@yahoo.es.
María Belén
MB
Martín-Águeda
Spanish Health Technology Assessment Agency, Instituto de Salud Carlos III, REDISSEC, Spanish Research Network on Chronic Diseases Health Services, Unit of Preventive Medicine and Public Health, University of Alcala, Madrid, Spain. Electronic address: asarria@isciii.es.
Antonio
A
Sarría-Santamera
D014355:Chagas Disease / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D054242:Emigrants and Immigrants; D005060:Europe; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007843:Latin America / Q000208:ethnology; D008297:Male; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D013030:Spain / Q000453:epidemiology; D014344:Trypanocidal Agents / Q000191:economics* / Q000627:therapeutic use
D014344:Trypanocidal Agents
Chagas disease; Costs and costs analysis; Screening; Spain