Echocardiographic screening for rheumatic heart disease in indigenous Australian children: A cost-utility analysis

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

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Article numbere004515
JournalJournal of the American Heart Association
Volume6
Issue number3
DOIs
Publication statusPublished - 2017

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Rheumatic Heart Disease
Cost-Benefit Analysis
Quality-Adjusted Life Years
Thoracic Surgery
Heart Failure
Costs and Cost Analysis
Child Mortality
Cost of Illness
Vulnerable Populations
Disease Progression
Early Diagnosis
Young Adult
Morbidity
Mortality
Population

Cite this

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title = "Echocardiographic screening for rheumatic heart disease in indigenous Australian children: A cost-utility analysis",
abstract = "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.",
keywords = "Cost-effectiveness, Echocardiography, Pediatrics, Rheumatic heart disease, Screening",
author = "Kathryn Roberts and Jeffrey Cannon and David Atkinson and Alex Brown and Graeme Maguire and Bo Remenyi and Gavin Wheaton and Elizabeth Geelhoed and Carapetis, {Jonathan R.}",
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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.

In: Journal of the American Heart Association, Vol. 6, No. 3, e004515, 2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Echocardiographic screening for rheumatic heart disease in indigenous Australian children

T2 - A cost-utility analysis

AU - Roberts, Kathryn

AU - Cannon, Jeffrey

AU - Atkinson, David

AU - Brown, Alex

AU - Maguire, Graeme

AU - Remenyi, Bo

AU - Wheaton, Gavin

AU - Geelhoed, Elizabeth

AU - Carapetis, Jonathan R.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Cost-effectiveness

KW - Echocardiography

KW - Pediatrics

KW - Rheumatic heart disease

KW - Screening

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U2 - 10.1161/JAHA.116.004515

DO - 10.1161/JAHA.116.004515

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 3

M1 - e004515

ER -