Economic burden of Chagas disease in Brazil: a nationwide cost-of-illness study

Abstract

Background: Chagas disease remains a public health issue with substantial financial impact on the healthcare system of Latin American countries. Despite its great economic burden, research quantifying the direct and indirect costs are limited, particularly within Brazil. This study estimates the economic burden of chronic Chagas disease in Brazil, as part of the broader project, 'The Burden of Chagas Disease in the Contemporary World: The RAISE Study'.

Methods: A Markov model was used to estimate the economic burden of chronic Chagas disease from a societal perspective considering six mutually exclusive health states: four clinical forms (indeterminate, cardiac, digestive, mixed) and two absorptive states (death and cure). This model was analyzed through microsimulation with a one-year cycle length, considering a hypothetical cohort of 10,000 patients, each repeated 1000 times to report the average. Data on costs were gathered, converted to 2024 purchasing power parity US dollars, and considered direct medical costs and productivity losses due to absenteeism.

Findings: The annual economic burden of chronic Chagas disease in Brazil was estimated at $11.44 billion, constituting 0.23% of the gross domestic product, with a lifetime cost per patient of $45,034. Lifetime direct medical costs represent around 72% of the total lifetime economic burden, while indirect costs, 28%. Annual direct medical costs represent around 11% of the Ministry of Health budget.

Interpretation: The significant economic burden highlights the necessity for effective public health policies and resource allocation in Brazil's healthcare system. Given the universal health coverage model, understanding these costs can guide improvements and interventions aimed at reducing Chagas disease's impact.

Funding: Funding was provided by Novartis Pharma AG as part of a research collaboration with the World Heart Federation, project number CLCZ696D2010R.

Keywords: Absenteeism; Brazil; Chronic Chagas disease; Direct medical costs; Economic burden; Indirect costs; Markov model; Societal perspective.

Fig. 1

Individual-based chronic Chagas disease Markov model structure. Notes: A Transition probability from indeterminate form to cure (8.0%). B Transition probability from indeterminate form to cardiac form (3.0%). C Transition probability from indeterminate form to digestive form (1.1%). D Transition probability from indeterminate form to death or from de cure to death (general mortality rate for population over 14 years old). E Transition probability from cardiac form to mixed form (1.1%). F Transition probability from cardiac form to death (7.9%). G Transition probability from digestive form to mixed form (3.0%). H Transition probability from digestive form to death (0.065% + general mortality rate for population over 14 years old). I Transition probability from mixed form to death (7.9%).

Fig. 2

Cost outputs estimated for chronic Chagas disease in Brazil.

Fig. 3

Effect of varying transition probabilities and inpatient costs on lifetime economic burden of chronic Chagas disease per patient in Brazil.