Financial toxicity and the economic burden of Chagas disease: a scoping review

This scoping review mapped, synthesized, and critically analyzed the evidence on financial toxicity in Chagas disease, focusing on its determinants, impacts, and management strategies. Financial toxicity refers to the financial burden and distress experienced by individuals and their families as a result of healthcare expenses. The review followed the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. Comprehensive searches were conducted across seven electronic databases and the gray literature. Studies were selected and data extracted independently using the population-exposure-outcome framework, and 14 studies included. Most studies described indicators of the economic burden of Chagas disease rather than directly measuring patient-level financial toxicity. Substantial indirect costs were associated with absenteeism, productivity loss, and premature mortality, accounting for 44% to 75% of total costs. The findings also indicated that financial hardship may be intensified by structural vulnerabilities, including extreme poverty, lack of health insurance, and precarious migration status. Available evidence suggests that individuals affected by Chagas disease are at increased risk of healthcare-related financial hardship. However, studies directly assessing financial toxicity are scarce, with most relying on indirect economic indicators. This highlights an important gap in the literature and underscores the need for validated measures to evaluate financial toxicity in this population. Interventions that reduce financial barriers and strengthen access to healthcare services may help mitigate the economic consequences of Chagas disease. Future research should prioritize patient-centered assessments of financial toxicity to better inform policies and strategies aimed at reducing the financial burden associated with the disease.