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 .

Diseases
Validation

Diseases presenting "fever" symptom

22q11.2 deletion syndrome

acute rheumatic fever

alexander disease

allergic bronchopulmonary aspergillosis

canavan disease

carcinoma of the gallbladder

child syndrome

congenital toxoplasmosis

cushing syndrome

cystinuria

dracunculiasis

erdheim-chester disease

esophageal adenocarcinoma

esophageal carcinoma

familial mediterranean fever

focal myositis

hodgkin lymphoma, classical

lamellar ichthyosis

legionellosis

locked-in syndrome

malignant atrophic papulosis

neonatal adrenoleukodystrophy

neuralgic amyotrophy

oculocutaneous albinism

papillon-lefèvre syndrome

pyomyositis

pyruvate dehydrogenase deficiency

scrub typhus

severe combined immunodeficiency

sneddon syndrome

systemic capillary leak syndrome

triple a syndrome

typhoid

waldenström macroglobulinemia

wolf-hirschhorn syndrome

This symptom has already been validated