Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10963
Title: Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost-Utility Analysis.
Authors: Roberts, Kathryn
Cannon, Jeffrey
Atkinson, David
Brown, Alex
Maguire, Graeme
Remenyi, Bo
Wheaton, Gavin
Geelhoed, Elizabeth
Carapetis, Jonathan R
Affiliation: Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia..
Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia jeffrey.cannon@telethonkids.org.au..
Rural Clinical School of Western Australia, University of Western Australia, Broome, Western Australia, Australia..
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia..
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia..
Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia..
Women's and Children's Hospital, Adelaide, South Australia, Australia..
Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia..
Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia..
Issue Date: 2-Mar-2017
Citation: Journal of the American Heart Association 2017-03-02; 6(3)
Abstract: Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and mortality in children and young adults in disadvantaged populations. The emergence of echocardiographic screening provides the opportunity for early disease detection and intervention. Using our own multistate model of RHD progression derived from Australian RHD register data, we performed a cost-utility analysis of echocardiographic screening in indigenous Australian children, with the dual aims of informing policy decisions in Australia and providing a model that could be adapted in other countries. We simulated the outcomes of 2 screening strategies, assuming that RHD could be detected 1, 2, or 3 years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability-adjusted life-years, and corresponding costs. Only a strategy of screening all indigenous 5- to 12-year-olds in half of their communities in alternate years was found to be cost-effective (incremental cost-effectiveness ratio less than AU$50 000 per disability-adjusted life-year averted), assuming that RHD can be detected at least 2 years earlier by screening; however, this result was sensitive to a number of assumptions. Additional modeling of improved adherence to secondary prophylaxis alone resulted in dramatic reductions in heart failure, surgery, and death; these outcomes improved even further when combined with screening. Echocardiographic screening for RHD is cost-effective in our context, assuming that RHD can be detected ≥2 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10963
DOI: 10.1161/JAHA.116.004515
Type: Journal Article
Subjects: cost‐effectiveness
echocardiography
pediatrics
rheumatic heart disease
screening
Adolescent
Australia
Cardiac Surgical Procedures
Child
Child, Preschool
Cost-Benefit Analysis
Disease Progression
Echocardiography
Female
Heart Failure
Humans
Male
Mass Screening
Mortality
Northern Territory
Quality-Adjusted Life Years
Rheumatic Heart Disease
Oceanic Ancestry Group
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