Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in South African children with pharyngitis: a cost-effectiveness analysis.

[acute rheumatic fever]

Acute rheumatic fever and subsequent rheumatic heart disease remain significant in developing countries . We describe a cost-effective analysis of 7 strategies for the primary prevention of acute rheumatic fever and rheumatic heart disease in children presenting with pharyngitis in urban primary care clinics in South Africa .We used a Markov model to assess the cost-effectiveness of treatment with intramuscular penicillin using each of the following strategies : (1 ) empirical (treat all ); (2 ) positive throat culture (culture all ); (3 ) clinical decision rule (CDR ) score ≥2 (CDR 2 +); (4 ) CDR score ≥3 (CDR 3 +); (5 ) treating those with a CDR score ≥2 plus those with CDR score <2 and positive cultures (CDR 2 +, culture CDR negatives ); (6 ) treating those with a CDR score ≥3 plus those with CDR score <3 and positive cultures (CDR 3 +, culture CDR negatives ); and (7 ) treat none . The strategies ranked in order from lowest cost were treat all ($11 .19 per child ), CDR 2 + ($11 .20 ); the CDR 3 + ($13 .00 ); CDR 2 +, culture CDR negatives ($16 .42 ); CDR 3 +, culture CDR negatives ($23 .89 ); and culture all ($27 .21 ). The CDR 2 + is the preferred strategy at less than $150 /quality-adjusted life year compared with the treat all strategy . A strategy of culturing all children compared with the CDR 2 + strategy costs more than $125 000 /quality-adjusted life year gained .Treating all children presenting with pharyngitis in urban primary care clinics in South Africa with intramuscular penicillin is the least costly . A strategy of using a clinical decision rule without culturing is overall the preferred strategy . A strategy of culturing all children may be prohibitively expensive .

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acute rheumatic fever

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