Cost-effectiveness analysis of rheumatic heart disease prevention strategies.
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.
Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Rizwan A
RA
Manji
Julia
J
Witt
Paramjit S
PS
Tappia
Young
Y
Jung
Alan H
AH
Menkis
Bram
B
Ramjiawan
D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004452:Echocardiography / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods; D015995:Prevalence; D012214:Rheumatic Heart Disease / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D013297:Streptococcus pyogenes / Q000302:isolation & purification
D000900:Anti-Bacterial Agents