A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in children with pharyngitis

Irlam, James H; Mayosi, Bongani M; Engel, Mark E; Gaziano, Thomas A

A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in children with pharyngitis

Journal Article

2013

Journal Title

South African Medical Journal

Link to Journal

https://dx.doi.org/10.7196/SAMJ.7244

Department

Primary Health Care Directorate

Faculty

Faculty of Health Sciences

Abstract

Primary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children depends on prompt and effective diagnosis and treatment of pharyngitis at the primary level of care. Cost-effectiveness modeling shows that the most cost-effective strategy for primary prevention in South Africa (SA) is to use a simple symptomatic clinical decision rule (CDR) to diagnose pharyngitis in children presenting at the primary level of care and then to treat them with a single dose of intramuscular penicillin. Treat All and CDR2+ strategies are affordable and simple and miss few cases of streptococcal pharyngitis at the primary level of care. The CDR2+ strategy is the most cost-effective for primary prevention of ARF and RHD in urban SA and should complement primordial and secondary prevention efforts.