Prevention might be better than cure for rheumatic heart disease

Prevention might be better than cure for rheumatic heart disease

How can health officials of low-income countries best allocate limited resources to tackle rheumatic heart disease? A new computer-based tool calculates the cost-effectiveness of various interventions and suggests prevention might be better than cure.

Rheumatic heart disease (RHD) is a chronic heart condition that carries high risk of heart attack and affects an estimated 32 million people worldwide. Its impact is greatest in low-income countries, where it arises from inadequately treated scarlet fever or strep throat. Inflammation resulting from these Streptococcus infections can cause acute rheumatic fever (ARF), which may progress to chronic RHD.

This multi-stage disease progression offers many prevention and treatment opportunities, but there are few guidelines on which are most affordable and cost-effective. In a new PLOS Neglected Tropical Diseases study, David Watkins at the University of Washington, USA, and colleagues developed a new tool to help health officials get the best results from their limited resources.

Using a hypothetical low-income African country, the researchers analyzed the free tool’s ability to weigh the costs and benefits of three types of interventions:

  • improving antibiotic treatment of strep throat in primary care settings to prevent ARF and RHD
  • identifying and treating people with a history of ARF and RHD to prevent recurrent attacks
  • increasing coverage of heart valve surgery for RHD sufferers to reduce the risk of heart attacks.

While the tool relies on underlying assumptions about the researchers’ hypothetical country, it found that in this setting, prevention was better than cure. Improving antibiotic treatment of strep throat to prevent ARF and RHD was calculated to be the most cost-effective option long term, though it would require an estimated $874,000 upfront investment. The authors note their tool has “immediate policy relevance” and call for renewed efforts to scale up RHD prevention.

For best accuracy, health officials using the tool would likely need to enter their own region’s data on key inputs, such as cost of interventions. Nonetheless, this tool could help prioritize the most cost-effective interventions to reduce the burden of rheumatic heart disease.

Research Article: Watkins D, Lubinga SJ, Mayosi B, Babigumira JB (2016) A Cost-Effectiveness Tool to Guide the Prioritization of Interventions for Rheumatic Fever and Rheumatic Heart Disease Control in African Nations. PLoS Negl Trop Dis 10(8): e0004860. doi:10.1371/journal.pntd.0004860

Image Caption: Streptococcus pyogenes, the bacterium which triggers ARF and RHD.

Image Credit: CDC

Author

Beth works at PLOS as Journal Media Manager. She read Natural Sciences, specializing in Pathology, at the University of Cambridge before joining PLOS in 2013. She feels fortunate to be able to read and write about the exciting new research published by PLOS.

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