# name
Cost-effectiveness of Chagas disease screening in Latin American
                migrants at primary health-care centres in Europe: a Markov
                model analysis

# metadata.dc.description.abstract[].value
BACKGROUND: Chagas disease is currently prevalent in European
                countries hosting large communities from Latin America. Whether
                asymptomatic individuals at risk of Chagas disease living in
                Europe should be screened and treated accordingly is unclear. We
                performed an economic evaluation of systematic Chagas disease
                screening of the Latin American population attending primary
                care centres in Europe. METHODS: We constructed a decision tree
                model that compared the test option (screening of asymptomatic
                individuals, treatment, and follow-up of positive cases) with
                the no-test option (screening, treating, and follow-up of
                symptomatic individuals). The decision tree included a Markov
                model with five states, related to the chronic stage of the
                disease: indeterminate, cardiomyopathy, gastrointestinal,
                response to treatment, and death. The model started with a
                target population of 100 000 individuals, of which 4.2% (95% CI
                2.2-6.8) were estimated to be infected by Trypanosoma cruzi. The
                primary outcome was the incremental cost-effectiveness ratio
                (ICER) between test and no-test options. Deterministic and
                probabilistic analyses (Monte Carlo simulations) were performed.
                FINDINGS: In the deterministic analysis, total costs referred to
                100 000 individuals in the test and no-test option were euro30
                903 406 and euro6 597 403 respectively, with a difference of
                euro24 306 003. The respective number of quality-adjusted
                life-years (QALYs) gained in the test and no-test option were 61
                820.82 and 57 354.42. The ICER was euro5442. In the
                probabilistic analysis, total costs for the test and no-test
                option were euro32 163 649 (95% CI 31 263 705-33 063 593) and
                euro6 904 764 (6 703 258-7 106 270), respectively. The
                respective number of QALYs gained was 64 634.35 (95% CI 62
                809.6-66 459.1) and 59 875.73 (58 191.18-61 560.28). The
                difference in QALYs gained between the test and no test options
                was 4758.62 (95% CI 4618.42-4898.82). The incremental
                cost-effectiveness ratio (ICER) was euro6840.75 (95% CI
                2545-2759) per QALY gained for a treatment efficacy of 20% and
                euro4243 per QALY gained for treatment efficacy of 50%. Even
                with a reduction in Chagas disease prevalence to 0.05% and with
                large variations in all the parameters, the test option would
                still be more cost-effective than the no-test option (less than
                euro30000 per QALY). INTERPRETATION: Screening for Chagas
                disease in asymptomatic Latin American adults living in Europe
                is a cost-effective strategy. Findings of our model provide an
                important element to support the implementation of T cruzi
                screening programmes at primary health centres in European
                countries hosting Latin American migrants. FUNDING: European
                Commission 7th Framework Program.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Cost-effectiveness of Chagas disease screening in Latin American
                migrants at primary health-care centres in Europe: a Markov
                model analysis