Cargando…
Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis
BACKGROUND: 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 mul...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524001/ https://www.ncbi.nlm.nih.gov/pubmed/28255077 http://dx.doi.org/10.1161/JAHA.116.004515 |
_version_ | 1783252398038319104 |
---|---|
author | Roberts, Kathryn Cannon, Jeffrey Atkinson, David Brown, Alex Maguire, Graeme Remenyi, Bo Wheaton, Gavin Geelhoed, Elizabeth Carapetis, Jonathan R. |
author_facet | Roberts, Kathryn Cannon, Jeffrey Atkinson, David Brown, Alex Maguire, Graeme Remenyi, Bo Wheaton, Gavin Geelhoed, Elizabeth Carapetis, Jonathan R. |
author_sort | Roberts, Kathryn |
collection | PubMed |
description | BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-5524001 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-55240012017-08-15 Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis Roberts, Kathryn Cannon, Jeffrey Atkinson, David Brown, Alex Maguire, Graeme Remenyi, Bo Wheaton, Gavin Geelhoed, Elizabeth Carapetis, Jonathan R. J Am Heart Assoc Original Research BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. John Wiley and Sons Inc. 2017-03-02 /pmc/articles/PMC5524001/ /pubmed/28255077 http://dx.doi.org/10.1161/JAHA.116.004515 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Roberts, Kathryn Cannon, Jeffrey Atkinson, David Brown, Alex Maguire, Graeme Remenyi, Bo Wheaton, Gavin Geelhoed, Elizabeth Carapetis, Jonathan R. Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title | Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title_full | Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title_fullStr | Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title_full_unstemmed | Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title_short | Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis |
title_sort | echocardiographic screening for rheumatic heart disease in indigenous australian children: a cost–utility analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524001/ https://www.ncbi.nlm.nih.gov/pubmed/28255077 http://dx.doi.org/10.1161/JAHA.116.004515 |
work_keys_str_mv | AT robertskathryn echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT cannonjeffrey echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT atkinsondavid echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT brownalex echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT maguiregraeme echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT remenyibo echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT wheatongavin echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT geelhoedelizabeth echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis AT carapetisjonathanr echocardiographicscreeningforrheumaticheartdiseaseinindigenousaustralianchildrenacostutilityanalysis |