Cost-effective but underused: evaluating screening strategies for indeterminate Chagas disease

Background

Chagas disease is a burdensome condition in non-endemic countries, yet underdiagnosed and underestimated. We aimed to assess cost-effectiveness of alternative screening models in Latin American residents in Italy.

Methods

A decision-analytic model combining a decision tree and a Markov model (annual cycles) was developed to simulate the lifetime progression of chronic disease. Four strategies were compared: usual care (no systematic screening), community-based active screening and two primary care–based approaches (standard and enhanced). Outcomes included costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB), from a healthcare system perspective, using a €30,000/QALY threshold. Deterministic and probabilistic sensitivity analyses assessed robustness.

Results

Preliminary results estimated that all screening strategies were cost-effective compared with usual care, with ICERs below the threshold. In the base-case analysis, ICERs were €8,397/QALY for active screening, €14,249/QALY for standard primary care and €7,360/QALY for enhanced primary care. Per 10,000 individuals, active screening generated the largest health gains (+101 QALYs) even if with higher incremental costs (€850,478). Deterministic sensitivity analysis was primarily driven by disease prevalence and treatment effectiveness, probabilistic analysis confirmed robustness, with mean ICERs of €24,140/QALY (active screening) and €21,551/QALY (enhanced primary care) and probabilities of cost-effectiveness of 89.1% and 90.1%, respectively.

Conclusions

The lack of systematic screening for Chagas disease in migrants is a missed opportunity to improve health outcomes and resource use. Community-based approaches maximise health gains, while strengthened primary care offers a resource-efficient and scalable option. These findings support the integration of Chagas screening into routine public health and primary care services in Europe.

Key messages

• Systematic screening for Chagas disease in Latin American populations in non-endemic countries is cost-effective and cost-useful compared with usual care.

• Primary care–based strategies provide an efficient and scalable alternative to community-based screening.