A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba

PloS One
David A WatkinsBongani M Mayosi

Abstract

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program. We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic ...Continue Reading

References

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Citations

Mar 5, 2016·Nature Reviews. Cardiology·Andrea Beaton, Craig Sable
May 10, 2016·Nature Reviews. Disease Primers·Gregory Y H LipDeirdre A Lane
Jul 28, 2010·Pediatric Rheumatology Online Journal·Christina F PelajoSheila Kf de Oliveira
Dec 1, 2017·BMC Health Services Research·Judith M KatzenellenbogenJonathan R Carapetis
Sep 8, 2018·Global Public Health·Marian AbouzeidJonathan Carapetis
Nov 22, 2016·The Pediatric Infectious Disease Journal·Mark E EngelGary Maartens
Mar 13, 2017·Current Treatment Options in Cardiovascular Medicine·Liesl J ZühlkeJonathan Carapetis
Apr 4, 2019·Pediatric Rheumatology Online Journal·Fortunata CondemiGianfranco De Maio
Oct 13, 2017·The Medical Journal of Australia·Rosemary WyberMichael Gannon
Jul 5, 2019·Revista Da Sociedade Brasileira De Medicina Tropical·Bruno Ramos Nascimento, Andrea Zawacki Beaton
Mar 12, 2021·The Lancet Child & Adolescent Health·Rosemary WyberJonathan Carapetis
Jul 5, 2021·BMC Public Health·Assegid G HelleboOlufunke Alaba

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