Date of Award

2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Michael Cappello MD

Second Advisor

Ravi Durvasula MD

Abstract

The purpose of this study was to perform a cost-benefit analysis of an intervention to treat all the children in Bolivia (under 15 years of age) who are infected with Chagas disease. This research was carried out in La Paz, Bolivia where the author lived for a year collecting data in collaboration with the National Chagas Control Program, Bolivian Ministry of Health. Operational costs were based on current prices for laboratory testing and pharmaceuticals, average hourly wages for health care workers, and the number of children who would be treated. The benefit of the program was estimated as the sum of direct and indirect costs associated with chronic cardiac disease caused by Chagas infection. Direct costs were calculated as the minimum amount needed for adequate medical treatment summed over the patients life span. Indirect costs were measured in Disability-Adjusted Life Years (DALYs) multiplied by average yearly salary to more fully account for the true burden of disease. Implementation cost was estimated to be approximately $35 million. This intervention would prevent over 279,000 DALYs and alleviate $123 million in direct and $632 million in indirect costs. Clearly, such a program would be extremely cost-effective. Thus, with an initial investment of less than $135 per infected child, approximately $2,900 worth of future costs would be prevented, in addition to improvements in quality of life not captured by DALYs. A sensitivity analysis showed that even while assuming a high variability of the data, the cost and benefit of this intervention were significantly different (p-value < 0.001).

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