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Roure S, López F, Oliva I, Pérez-Quílez O, March O, Chamorro A, Abad E, Muñoz IL, Castillo A, Soldevila L, Valerio L, Lozano M, Masnou H, Oliveira M, Cañas L, Gibrat M, Chuecos M, Montero JJ, Colmenares K, Falguera G, Bonet JM, Isnard M, Prat N, Estrada O, Clotet B, Vallès X. Schistosomiasis screening in non-endemic countries from a cost perspective: Knowledge gaps and research priorities. The case of African long-term residents in a Metropolitan Area, Spain. PLoS Negl Trop Dis 2023; 17:e0011221. [PMID: 37014919 PMCID: PMC10104311 DOI: 10.1371/journal.pntd.0011221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 04/14/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. OBJECTIVE To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. METHODOLOGY We calculated the costs associated with three approaches-presumptive treatment, test-and-treat and watchful waiting-under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. RESULTS Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. CONCLUSION Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants.
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Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Fight and Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Francesc López
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Irene Oliva
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Oriol March
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
| | - Anna Chamorro
- Fight and Infectious Diseases Foundation, Badalona, Spain
| | - Elena Abad
- Fight and Infectious Diseases Foundation, Badalona, Spain
| | - Israel López Muñoz
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Amaia Castillo
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Manolo Lozano
- Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Helena Masnou
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Oliveira
- Urology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Cañas
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Gibrat
- Primary Health Care Unit Canovelles, North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Granollers, Spain
| | - Marta Chuecos
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Badalona, Spain
| | - Juan José Montero
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Badalona, Spain
| | - Karen Colmenares
- Unitat de Suport Assistencial i Avaluació (USUAiA), Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Gemma Falguera
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Josep Maria Bonet
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Núria Prat
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain
| | - Bonaventura Clotet
- Fight and Infectious Diseases Foundation, Badalona, Spain
- IrsiCaixa-Institut de Recerca de La SIDA, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Direcció Territorial Malalties Infeccioses, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Fight and Infectious Diseases Foundation, Badalona, Spain
- Institut de Recerca Germans Trias i Pujol, Badalona, Spain
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