PLoS neglected tropical diseases · 2014 · 45 citations · 19 references
A robust model is needed to analyze the costs and impacts of timely clinical attention for Chagas disease in Mexico, where the disease is currently neglected in public health programs. A Markov decision model simulated the natural history of a Chagas disease cohort in Mexico to project short‑ and long‑term clinical outcomes and costs. The model shows that timely diagnosis and treatment reduces lifetime costs from US$11,877 to US$10,160, with costs rising 24‑fold from early acute to indeterminate stages, and that working‑day losses account for 44–75% of lifetime costs, making early intervention cheaper and improving quality of life, thereby supporting policy shifts to include treatment in national formularies.
Background Given current neglect for Chagas disease in public health programs in Mexico, future healthcare and economic development policies will need a more robust model to analyze costs and impacts of timely clinical attention of infected populations. Methodology/Principal Findings A Markov decision model was constructed to simulate the natural history of a Chagas disease cohort in Mexico and to project the associated short and long-term clinical outcomes and corresponding costs. The lifetime cost for a timely diagnosed and treated Chagas disease patient is US$ 10,160, while the cost for an undiagnosed individual is US$ 11,877. The cost of a diagnosed and treated case increases 24-fold from early acute to indeterminate stage. The major cost component for lifetime cost was working days lost, between 44% and 75%, depending on the program scenario for timely diagnosis and treatment. Conclusions/Significance In the long term, it is cheaper to diagnose and treat chagasic patients early, instead of doing nothing. This finding by itself argues for the need to shift current policy, in order to prioritize and attend this neglected disease for the benefit of social and economic development, which implies including treatment drugs in the national formularies. Present results are even more relevant, if one considers that timely diagnosis and treatment can arrest clinical progression and enhance a chronic patient's quality of life.
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Markov Models in Medical Decision Making
Frank A. Sonnenberg, J. Robert Beck · Medical Decision Making · 1993 · 2.4K citations
Diana Fabbro, Mirtha L. Streiger, Enrique Arias et al. · Revista da Sociedade Brasileira de Medicina Tropical · 2007 · 230 citations · Full text