The economic burden of Chagas disease: A systematic review

Background: Chagas disease (CD) is a neglected disease affecting millions worldwide, yet little is known about its economic burden. This systematic review is part of RAISE project, a broader study that aims to estimate the global prevalence, mortality, and health and economic burden attributable to chronic CD and Chronic Chagas cardiomyopathy. The objective of this study was to assess the main costs associated with the treatment of CD in both endemic and non-endemic countries. Methods: An electronic search of the Medline, Lilacs, and Embase databases was conducted until 31st, 2022, to identify and select economic studies that evaluated treatment costs of CD. No restrictions on place or language were made. Complete or partial economic analyses were included. Results: Fifteen studies were included, with two-thirds referring to endemic countries. The most commonly investigated cost components were inpatient care, exams, surgeries, consultation, drugs, and pacemakers. However, significant heterogeneity in the estimation methods and presentation of data was observed, highlighting the absence of standardization in the measurement methods and cost components. The most common component analyzed using the same metric was hospitalization. The mean annual hospital cost per patient ranges from $25.47 purchasing power parity US dollars (PPP-USD) to $18,823.74 PPP-USD, and the median value was $324.44 PPP-USD. The lifetime hospital cost per patient varies from $209,44 PPP-USD for general care to $14,351.68 PPP-USD for patients with heart failure. Discussion: Despite the limitations of the included studies, this study is the first systematic review of the costs of CD treatment. The findings underscore the importance of standardizing the measurement methods and cost components for estimating the economic burden of CD and improving the comparability of cost components magnitude and cost composition analysis. Finally, assessing the economic burden is essential for public policies designed to eliminate CD, given the continued neglect of this disease. Author summary: Chagas disease is a global health concern with significant economic implications, yet our understanding of its economic burden remains limited. As part of the RAISE project, aimed at estimating the global impact of chronic Chagas disease and chronic Chagas cardiomyopathy, we conducted a systematic review to assess the costs associated with Chagas Disease treatment in both endemic and non-endemic countries. We identified fifteen studies. The most commonly investigated cost components included inpatient care, exams, surgeries, consultations, drugs, and pacemakers. We found substantial heterogeneity in estimation methods and data presentation, revealing a lack of measurement and cost components standardization. Our systematic review represents the first comprehensive assessment of Chagas Disease treatment costs. Our findings emphasize the need for standardized measurement methods and cost components to improve comparability and facilitate economic burden estimation. The high costs of invasive treatments for cardiomyopathies remain challenging for low and middle-income countries. Estimating the economic burden of Chagas disease provides crucial information for conducting policy evaluations and interventions. For instance, these studies can support international agencies in funding research for vaccine development and improved vector control programs. While vaccine research is in its early stages, promising antiparasitic therapies offer potential for disease control.