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COST-EFFECTIVENESS OF CHAGAS DISEASE INTERVENTIONS IN LATIN AMERICA AND THE CARIBBEAN: MARKOV MODELS

Chagas disease is a parasitic disease in Latin America. Despite vector control programs that have reduced incidence by 70%, there are at least 12–14 million prevalent cases. We used a Markov model to examine strategies for control and treatment of Chagas disease that compared annual costs, life expectancies, and cost-effectiveness of three vector control and drug treatment strategies. Vector control programs alone and vector control plus drug treatment are dominant over no vector control (i.e., less costly and save more lives), and vector control plus drug is highly cost-effective compared with vector control alone. We demonstrated expected changes in deaths over time resulting from various prevention approaches. Vector control affects primarily incidence, not decreasing deaths and prevalence for 30 years, while drug treatment affects prevalence and deaths immediately. The best strategy to combat Chagas disease is combinations of vector control and a potential new drug.

Received March 28, 2005. Accepted for publication June 16, 2005.

Disclosure: Leslie S. Wilson received consulting fees from OneWorld Health, a non-profit pharmaceutical company that is in the early stages of development of a drug for treatment of Chagas disease. This statement is made in the interest of full disclosure and not because the author considers this to be a conflict of interest.

^* Address correspondence to Leslie S. Wilson, Departments of Medicine and Pharmacy, University of California, San Francisco, Box 0613, 3333 California Street, San Francisco, CA 94143. E-mail: lwilson{at}itsa.ucsf.edu

Authors’ addresses: Leslie S. Wilson, Departments of Medicine and Pharmacy, University of California, San Francisco, Box 0613, 3333 California Street, San Francisco, CA 94143, Telephone: 415-502-5092, Fax: 415-502-0792, E-mail: wilsonL{at}pharmacy.ucsf.edu. Arthur M. Strosberg, Institute for OneWorld Health, 580 California Street, Suite 900, San Francisco, CA 94104, Telephone: 415-421-4700, Fax: 415-421-4747, E-mail: astrosberg{at}oneworldhealth.org. Kimberly Barrio, Business Development Institute for OneWorld Health, 580 California Street, Suite 900, San Francisco, CA 94104, Telephone: 415-421-4700, Fax: 415-421-4747, E-mail: kbarrio{at}oneworldhealth.org.

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