title: A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in children with pharyngitis.
abstract: Primary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children depends on prompt and effective diagnosis and treatment of pharyngitis at the primary level of care. Cost-effectiveness modeling shows that the most cost-effective strategy for primary prevention in South Africa (SA) is to use a simple symptomatic clinical decision rule (CDR) to diagnose pharyngitis in children presenting at the primary level of care and then to treat them with a single dose of intramuscular penicillin. Treat All and CDR2+ strategies are affordable and simple and miss few cases of streptococcal pharyngitis at the primary level of care. The CDR2+ strategy is the most cost-effective for primary prevention of ARF and RHD in urban SA and should complement primordial and secondary prevention efforts.
authors.affiliation: Primary Health Care Directorate, University of Cape Town, South Africa. james.irlam@uct.ac.za.
authors.forename: James H
authors.initials: JH
authors.lastname: Irlam
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaziano
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D010406:Penicillins / Q000008:administration & dosage / Q000009:adverse effects; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015995:Prevalence; D011314:Preventive Health Services / Q000191:economics / Q000379:methods; D012041:Regional Medical Programs / Q000191:economics*; D012213:Rheumatic Fever / Q000517:prevention & control*; D012214:Rheumatic Heart Disease / Q000517:prevention & control*; D013019:South Africa / Q000453:epidemiology; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins