title: Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model.
abstract: OBJECTIVE
  To project the cost-effectiveness of population-based echo screening to prevent rheumatic heart disease (RHD) consequences.
  
  
  BACKGROUND
  RHD is a leading cause of cardiovascular mortality and morbidity during adolescence and young adulthood in low- and middle-per capita income settings. Echocardiography-based screening approaches can dramatically expand the number of children identified at risk of progressive RHD. Cost-effectiveness analysis can inform public health agencies and payers about the net economic benefit of such large-scale population-based screening.
  
  
  METHODS
  A Markov model was constructed comparing a no-screen to echo screen approach. The echo screen program was modeled as a 2-staged screen of a cohort of 11-year-old children with initial short screening performed by dedicated technicians and follow-up complete echo by cardiologists. Penicillin RHD prophylaxis was modeled to only reduce rheumatic fever recurrence-related exacerbation. Quality-adjusted life years (QALYs) and societal costs (in 2010 Australian dollars) associated with each approach were estimated. One-way, two-way and probabilistic sensitivity analyses were performed on RHD prevalence and transition probabilities; echocardiography test characteristics; and societal level costs including supplies, transportation, and labor.
  
  
  RESULTS
  The incremental costs and QALYs of the screen compared to no screen strategy were -$432 (95% CI = -$1357 to $575) and 0.007 (95% CI = -0.0101 to 0.0237), respectively. The joint probability that the screen was both less costly and more effective exceeded 80%. Sensitivity analyses suggested screen strategy dominance depends mostly on the probability of transitioning out of sub-clinical RHD.
  
  
  CONCLUSIONS
  Two-stage echo RHD screening and secondary prophylaxis may achieve modestly improved outcomes at lower cost compared to clinical detection and deserves closer attention from health policy stakeholders.
authors: Department of Cardiology, Boston Children's Hospital , Boston, MA , USA and.
authors: Justin P
authors: JP
authors: Zachariah
authors: Mihail
authors: M
authors: Samnaliev
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D002648:Child; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics*; D006350:Heart Valve Prosthesis / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D017059:Models, Econometric; D015876:Northern Territory / Q000453:epidemiology; D010401:Penicillin G Benzathine / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012213:Rheumatic Fever / Q000517:prevention & control; D012214:Rheumatic Heart Disease / Q000175:diagnosis* / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine
keywords: Cost-benefit analysis; Echocardiography; Pediatrics; Rheumatic heart disease; Valves
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