Cost-effective but underused: evaluating screening strategies for indeterminate Chagas disease
Abstract
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.
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BibTeX
@article{marraffa2026costeffective,
title = {{Cost-effective but underused: evaluating screening strategies for indeterminate Chagas disease}},
author = {P Marraffa and L Marega and MM Gianino},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.394},
url = {https://doi.org/10.1093/eurpub/ckag169.394},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cost-effective but underused: evaluating screening strategies for indeterminate Chagas disease
AU - P Marraffa
AU - L Marega
AU - MM Gianino
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.394
UR - https://doi.org/10.1093/eurpub/ckag169.394
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -