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...

Descripción completa

Detalles Bibliográficos
Autores principales: Roberts, Kathryn, Cannon, Jeffrey, Atkinson, David, Brown, Alex, Maguire, Graeme, Remenyi, Bo, Wheaton, Gavin, Geelhoed, Elizabeth, Carapetis, Jonathan R.
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