Cost–effectiveness analysis of rheumatic heart disease prevention strategies

Abstract

Rheumatic heart disease (RHD), secondary to group A streptococcal infection is endemic in the developing as well as parts of the developed world with significant costs to the patient, and to the healthcare system. We briefly review the prevalence and cost of RHD in developed and developing nations. We subsequently develop a Markov model to evaluate the cost-effectiveness of three strategies (vs standard no prevention) for preventing RHD in a developing world country: primary prophylaxis (throat swab to detect and subsequently treat group A streptococci as needed); primary prophylaxis (antibiotic prophylaxis for all) with benzathine penicillin G once monthly to all patients (ages 5–21 years) regardless of evidence of infection; and secondary prophylaxis with monthly only to those with echocardiographic evidence of early RHD. Our model suggests that echocardiographic screening and secondary prophylaxis is the best strategy although the strategies change depending on parameters used.

Keywords::

• cost-effectiveness
• developing and low socioeconomic status populations in developed nations
• prevention strategies
• primary prophylaxis
• rheumatic fever
• rheumatic heart disease
• secondary prophylaxis

Acknowledgement

The authors would like to thank the St. Boniface Hospital Foundation for infrastructural support.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • High incidence of rheumatic heart disease (RHD) in the youth in the developing world and in low socioeconomic status populations in developed countries at significant cost to the patient and the healthcare system.

• • There is a lack of care and accessibility to treatment centers as well as adherence to guideline-recommended treatments.

• • Our study shows that echocardiography and long-term antibiotic prophylaxis for only those with early evidence of RHD is the most cost-effective strategy in a developing world nation; though the best method for prevention of RHD depends on: the estimated direct and indirect costs of RHD; the probability of getting RHD from group A streptococci if there is no treatment for group A streptococci; the costs of antibiotic prophylaxis; and the number of people that an ECHO technician can screen per year.

• • Preventing RHD in developing world nations is cost-effective and prophylactic/preventative strategies should be considered by policy-makers.

Notes