title: Will genetic testing alter the management of disease caused by infectious agents? A cost-effectiveness analysis of gene-testing strategies for prevention of rheumatic Fever.
abstract: Cost-effectiveness analysis was done to evaluate the potential health and economic effects of a genetic screening program to identify individuals at risk for rheumatic fever (RF). The current RF prevention strategy was compared with a new, primary prevention strategy involving early genetic testing and intensive prophylaxis to prevent a first attack among individuals at high risk for RF. When analysis of a hypothetical 2000 birth cohort was done from a societal perspective, the prevention strategy involving genetic screening and prophylaxis for high-risk persons reduced the number of RF cases and increased life span at an estimated discounted cost of $7900 per quality-adjusted life-year gained. Genetic screening became the preferred (least expensive) strategy if the test specificity was >/=98%, the annual cost of prophylaxis was <$550, or the annual cost of caring for an individual with severe rheumatic heart disease increased to >$32,000. When used with available antibiotic prophylaxis, genetic testing has the potential to provide a cost-effective strategy for the primary prevention of RF and its sequelae.
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA. chk@po.cwru.edu
authors.forename: Charles H
authors.initials: CH
authors.lastname: King
authors.forename: Diana F
authors.initials: DF
authors.lastname: Fischler
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gerkin
mesh_terms: D019072:Antibiotic Prophylaxis; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D017063:Outcome Assessment, Health Care; D010612:Pharyngitis / Q000191:economics / Q000382:microbiology; D012213:Rheumatic Fever / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D013291:Streptococcus; D016896:Treatment Outcome