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

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

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.


Authors' affiliations

James H Irlam, Primary Health Care Directorate, University of Cape Town, South Africa

Bongani M Mayosi, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Mark E Engel, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Thomas A Gaziano, Department of Cardiology, Brigham and Women's Hospital, Boston, USA

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Keywords

rheumatic heart disease; primary prevention; cost-effectiveness; acute rheumatic fever; WHO clinical decision rule

Cite this article

South African Medical Journal 2013;103(12):894-895. DOI:10.7196/SAMJ.7244

Article History

Date submitted: 2013-07-07
Date published: 2013-09-03

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