Date Published: November 18, 2008
Publisher: Public Library of Science
Author(s): Marianela Castillo-Riquelme, Felipe Guhl, Brenda Turriago, Nestor Pinto, Fernando Rosas, Mónica Flórez Martínez, Julia Fox-Rushby, Clive Davies, Diarmid Campbell-Lendrum, Ricardo E. Gurtler
Abstract: BackgroundThe 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.MethodsData 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.FindingsThe 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.ConclusionChagas 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.
Partial Text: Chagas disease (American trypanosomiasis) has its origin in the American continent; however, due to increasing population migration to North America and Europe, the disease has expanded beyond its original borders. This parasitic disease has two principal routes of transmission to humans; by blood-sucking triatomine bug vectors and by blood transfusion. In 2004 it was estimated that 3 million Colombians (about 7% of the country’s population) were at significant risk of infection as they lived in high-risk areas, and that 1.3 million were infected . The main health impact of infection with Trypanosoma cruzi (Chagas) is chronic Chagas disease, which manifests in an estimated 10 to 30% of all infected patients . This happens approximately 15 to 25 years after infection and consists of cardiomyopathies with or without congestive heart failure. For some patients the disease is fatal, while for others, expensive medical procedures such as implantation of pacemakers are needed.
The cost results of this study and those reported by the international literature are shown in Table 6. The costs of vector control activities were lower in comparison to previous studies and these were highly dependant on the cost of the insecticide. Treatment costs varied widely among different levels of care and between patients with C with and without CHF. Care seeking behaviour and utilisation patterns suggest that patients delay treatment; most of them received care of an intermediate level (42%); few would use specialised levels of care (12%), and 22% would remain untreated except for palliative care near death.