Introduction: The Persistent Challenge of Chagas Disease
Chagas disease (ChD), caused by the protozoan parasite Trypanosoma cruzi, remains one of the most significant public health challenges in Latin America. Once primarily a rural disease associated with poor housing and vector-borne transmission, it has evolved into a complex chronic condition affecting urban populations and requiring lifelong medical management. While vector control programs have successfully reduced new infections in many regions, the silent nature of the disease means that millions of individuals remain in the chronic phase, often undiagnosed until severe cardiac or gastrointestinal complications arise.
The economic implications of this transition are profound. As patients age, the disease frequently progresses from an indeterminate, asymptomatic phase to chronic Chagas cardiomyopathy (CCC), a debilitating condition characterized by arrhythmias, heart failure, and thromboembolism. The RAISE study (Research on the Analysis of the Impact and Socio-economic burden of Chagas disease) provides a critical update on the economic dimensions of this neglected tropical disease, offering a population-based cost-of-illness analysis across seven endemic countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Paraguay.
Highlights
- The lifetime economic burden of Chagas disease is staggering, reaching an estimated US$252 billion in Brazil and US$164 billion in Argentina (2024 PPP).
- In high-burden countries like Bolivia and Argentina, the economic impact represents approximately 0.9% and 0.8% of the annual Gross Domestic Product (GDP), respectively.
- A critical epidemiological shift is occurring: while overall prevalence is declining, the proportion of patients with severe cardiac forms is increasing due to population aging and disease progression.
- Chronic Chagas disease accounts for up to 6% of total health expenditures in the most affected nations, signaling an urgent need for targeted resource allocation.
Study Design and Methodology
The RAISE study employed a robust methodological framework to capture both direct medical and indirect costs associated with chronic Chagas disease (CCD). The researchers utilized a Markov model with one-year cycles and six distinct health states: indeterminate (asymptomatic), three stages of cardiac involvement (mild, moderate, and severe), gastrointestinal involvement, and death.
Data for the model were drawn from the Global Burden of Disease (GBD) Study 2023, ensuring a contemporary epidemiological foundation. To reflect the economic reality of different nations, all costs were converted to 2024 purchasing power parity (PPP) US dollars. This approach allows for a more accurate comparison of the economic burden across countries with varying price levels and healthcare systems.
The model parameters, initially developed for a Brazilian context, were meticulously adjusted for each of the other six countries. This was achieved using ratios of healthcare coverage and per capita health expenditure, with further refinement and validation provided by national experts in each respective country. By adopting a societal perspective, the study accounted not only for direct healthcare costs (hospitalizations, medications, diagnostics) but also for indirect costs related to productivity loss due to morbidity and premature mortality.
Key Findings: A Heavy Price for a Neglected Disease
The Magnitude of the Economic Burden
The findings underscore the disproportionate economic impact of Chagas disease in the Southern Cone. In 2010, Brazil and Argentina bore the highest lifetime burdens, at US$252 billion and US$164 billion, respectively. Even when considering annual impacts as a percentage of GDP, the figures remain alarming. Bolivia (0.9%) and Argentina (0.8%) faced the most significant relative burdens. In these countries, the cost of managing CCD represents roughly 6% of the total national health expenditure, a figure that rivals many high-profile non-communicable diseases.
Epidemiological Shifts and the Cardiac Burden
One of the most significant insights from the RAISE study is the changing face of Chagas disease. Between 2010 and 2023, most countries observed a decline in the absolute economic burden, primarily due to a reduction in the total number of infected individuals. However, this trend is counterbalanced by a worrying increase in the complexity of cases.
As the population of infected individuals ages, a higher proportion is transitioning into advanced cardiac states. Chronic Chagas cardiomyopathy is significantly more expensive to treat than the indeterminate form, requiring complex interventions such as pacemakers, implantable cardioverter-defibrillators (ICDs), and frequent hospitalizations for heart failure. This means that even as the number of patients decreases, the cost per patient is rising, placing a sustained or even increased pressure on specialized cardiac care units.
Direct vs. Indirect Costs
The study highlights that indirect costs—specifically those related to premature death and the inability to work—constitute a major portion of the total economic burden. Because Chagas disease often affects individuals in their most productive years, the loss of labor contributes significantly to the stunting of regional economic growth. Direct medical costs are also substantial, particularly in countries with higher healthcare access, where the cost of managing chronic heart failure and associated complications is high.
Expert Commentary: Moving Beyond Vector Control
Historically, the public health response to Chagas disease has focused heavily on vector control (eliminating the ‘kissing bug’ from households). While these efforts have been remarkably successful, the RAISE study demonstrates that the battle is far from over. The “legacy” of past infections is now manifesting as a wave of chronic cardiac disease that the region’s healthcare systems must be prepared to handle.
Clinicians and policymakers must recognize that Chagas disease is now a major driver of heart failure in Latin America. The transition to more severe cardiac forms necessitates a shift in strategy. Early diagnosis and treatment with antiparasitic drugs like benznidazole or nifurtimox, while most effective in the acute or early chronic phase, must be coupled with improved access to specialized cardiology services. Furthermore, there is a clear need for increased screening in urban centers, as migration has moved the disease from rural areas to major cities where healthcare costs are inherently higher.
Limitations of the study include the reliance on GBD prevalence estimates, which may vary in accuracy by region, and the challenges of modeling indirect costs in informal economies. However, the use of expert validation and PPP adjustments provides the most comprehensive economic snapshot of Chagas disease to date.
Conclusion: A Call for Resource Allocation
The RAISE study serves as a stark reminder that Chagas disease is not just a clinical issue but a major economic hurdle for Latin American development. The findings provide a data-driven foundation for policymakers to advocate for increased funding and tailored interventions.
To mitigate the economic burden, healthcare systems must prioritize:
1. Strengthening early detection and screening programs to identify patients before they progress to severe cardiac stages.
2. Expanding access to essential cardiovascular medications and interventions.
3. Integrating Chagas disease management into primary healthcare frameworks to reduce the reliance on expensive, late-stage hospital care.
As the region faces an aging population, the costs associated with chronic Chagas cardiomyopathy will only intensify unless proactive measures are taken today.
Funding and References
Funding for this study was provided by Novartis Pharma AG as part of a research collaboration with the World Heart Federation (project number CLCZ696D2010R).
References
1. Andrade MV, Noronha KVMS, de Souza A, et al. Economic burden of Chagas disease in Latin American countries: a population-based cost-of-illness analysis from the RAISE study. Lancet Reg Health Am. 2025;54:101340. doi:10.1016/j.lana.2025.101340.
2. World Health Organization. Chagas disease (also known as American trypanosomiasis). Fact Sheet. 2024.
3. Global Burden of Disease 2023 Study. Institute for Health Metrics and Evaluation (IHME).
