Cost-effectiveness analysis of screening for congenital Chagas disease in a non-endemic area.

Abstract

Chagas disease (CD) is an emerging public health concern in Europe. In non-endemic countries, congenital transmission is the main route of new infections. Italy is the second-largest host country in Europe for Latin American migrants and the prevalence of the disease is estimated around 3.5%. The aim is to evaluate the cost-effectiveness of a congenital CD screening program in pregnant women at risk of infection living in Italy and their newborns. We conducted a cost-effectiveness analysis from the perspective of the Italian National Health Service, comparing a screening scenario with a no-screening scenario. A Bayesian decision tree model with a lifetime horizon was developed. In the base-case analysis, the screening strategy yielded an incremental cost-effectiveness ratio of €15,193 per quality-adjusted life year gained (95% CI: €14,885-€15,552), falling well within the accepted cost-effectiveness threshold (€30,000-€50,000) in Italy. Probabilistic sensitivity analysis confirmed the robustness of these findings. Here we show that screening for congenital CD is a cost-effective strategy that improves health outcomes and aligns with international public health priorities. Our findings support the implementation of a national screening program integrated within existing maternal care pathways, contributing to the prevention of neglected tropical diseases and the promotion of migrant health.