Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening

Abstract

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother-child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.

Human Placental Trophoblasts Are Resistant to Trypanosoma cruzi Infection in a 3D-Culture Model of the Maternal-Fetal Interface

“…There is no vaccine to prevent CD and the available anti-parasitic drugs (benznidazole and nifurtimox) are contraindicated for pregnant women. Yet, the efficacy of benznidazole treatment in infants younger than 1 year ranges from 90 to 100% and consequently early diagnosis and therapeutic interventions can prevent the development of chronic CD later in life ( Perez-Zetune et al, 2020 ).…”

Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017)

“…Die Therapie ist gut verträglich und effektiv mit serologischen Heilungsraten von > 90 % [ 62 , 63 ]. Eine ökonomische Analyse aus den USA zeigte, dass ein generelles maternales Screening bereits bei sehr geringer mütterlicher Prävalenz und niedrigen vertikalen Transmissionsraten eine kostensparende Maßnahme darstellt [ 64 ]. Aus diesen Gründen erscheint ein generelles Screening von Mädchen und Frauen im gebärfähigen Alter aus Lateinamerika (insbesondere Bolivien) sinnvoll.…”

Retorno social de la inversión tras eliminar la transmisión vertical de chagas, VIH/sida, HB y sífilis: caso de un municipio de la Provincia de Buenos Aires

“…Otro estudio reciente (Perez-Zetune et al, 2020) valoró los costos de la detección materna, las pruebas y el tratamiento de los lactantes para la enfermedad de Chagas en los Estados Unidos y los comparó con los costos sociales de por vida sin pruebas y las consiguientes morbilidad y mortalidad por falta de tratamiento o tratamiento tardío. Como resultado, se obtuvo un ahorro por nacimiento de 1314 dólares en un programa de detección selectiva y de 105 dólares con la detección universal.…”