Opportunity Cost for Early Treatment of Chagas Disease in Mexico Janine M. Ramsey 1 , Miguel Elizondo-Cano 2 , Gilberto Sanchez-Gonza ´ lez 2 , Adriana Pen ˜ a-Nieves 3 , Alejandro Figueroa-Lara 4 * 1 Regional Center for Public Health Research, National Institute for Public Health Research, Tapachula, Chiapas, Mexico, 2 Center for Research in Health Systems, National Institute for Public Health Research, Cuernavaca, Mexico, 3 Salud, Poblacio ´ n y Economı ´a AC, Mexico City, Mexico, 4 Epidemiological Research Unit and Health Services, National Medical Center XXI Century, Mexican Social Security Institute, Mexico City, Mexico Abstract 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. Citation: Ramsey JM, Elizondo-Cano M, Sanchez-Gonza ´lez G, Pen ˜ a-Nieves A, Figueroa-Lara A (2014) Opportunity Cost for Early Treatment of Chagas Disease in Mexico. PLoS Negl Trop Dis 8(4): e2776. doi:10.1371/journal.pntd.0002776 Editor: Ricardo E. Gu ¨ rtler, Universidad de Buenos Aires, Argentina Received June 17, 2013; Accepted February 22, 2014; Published April 17, 2014 Copyright: ß 2014 Ramsey et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The funding source for the present study is the grant CONACyT-FONSEC #161405, to JMR. The CONACyT’s website is: www.conacyt.mx. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: fila0208@gmail.com Introduction Chagas Disease (CD) is caused by the flagellated protozoan parasite Trypanosoma cruzi (T.cruzi) [1], vectored by triatomine insects known as kissing bugs. The parasite is transmitted most often via the bug’s feces, and to a much lesser extent via blood transfusion, congenital or alimentary transmission, and organ transplant or laboratory accident [2,3]. The disease is endemic in 21 Latin-American countries and the United States, although human migration has expanded at-risk populations for most transmission modes in previously considered non-endemic countries [4]. In Mexico, more than 71,000,000 inhabitants are at direct risk in both rural and urban areas for vector transmission from one of 18 vector species [5,6]. The current prevalence is not well documented, although most estimates suggest between 0.013%–3.12% of the Mexican population are seropositive [7,8] and 650,000 chronic cases are currently in some form of clinical care in one of the many health care systems [9]. The first National Seroepidemiology Survey in Me ´xico, found a 1.6% seroprevalence of antibodies to T. cruzi (66,678 samples tested) at the national level. The highest prevalence was found in Chiapas (5.0%), Oaxaca (4.5%) and the south-east region, followed by the central plains of the temperate Huasteca region, which includes the states of Hidalgo (3.2%), San Luis Potosı ´ (2.5%), Veracruz (3.0%) and Tamaulipas (1.6%). However, a limitation of that study was its poor coverage of rural areas, which may have led to a significant underestimate of the current prevalence of the infection and disease [10]. Blood transfusion risk also exists, the review of 64,969 blood donors in 18 states of Mexico, demonstrated a 1.5% seropositivity, with prevalence ranging from 0.2% in Chihuahua up to 2.8% in Hidalgo. A more recent study of blood donations in the Social Security system (IMSS), highlights a similar profile and suggests that in urban populations, 0.4% are seropositive [7]. About 2000 inhabitants each year could be at risk of infection with T. cruzi via blood transfusion [11]. Analysis of the economics surrounding a disease can generate information essential for decision-making and evidence-based adoption of specific prevention and control policies. This is particularly useful for health sector authorities in order to generate greater social benefit with a lower cost to the health system [12]. It PLOS Neglected Tropical Diseases | www.plosntds.org 1 April 2014 | Volume 8 | Issue 4 | e2776