Novel Tool Developed to Create an Effective, Inexpensive Treatment Plan

Researchers have created a tool that can assist in making decisions about preventing and treating rheumatic heart disease (RHD), which causes hundreds of thousands of deaths per year.

The disease-burden of RHD is most common among patients in resource-poor areas. Treatment and prevention measures exist, but can be expensive, and go largely underused in these populations.

Acute rheumatic fever (ARF) and RDH develop as complications of an improperly treated infection by group A streptococcus bacteria, such as strep throat or scarlet fever. Inflammation from ARF can damage heart valves, and can lead to heart failure, stroke, and death.

Initial antibiotic treatment of infections can prevent disease progression in patients with a history of ARF or RHD, according to a study published by PLOS Neglected Tropical Diseases. Valve surgery could also be used to treat and prevent heart failure.

For ARF/RHD, there are few guidelines on how cost-effective and affordable patients’ options are. As a result, researchers created a tool to help physicians choose the proper treatment for a patient, in hopes that the tool will help integrate ARF and RHD priorities, according to the study.

In the study, researchers used a hypothetical African country to implement their tool.

They considered 3 interventions to prevent RHD:

• Increase primary prevention (PP) services to treat pharyngitis in a primary care setting.
• Increase secondary prevention (SP) services to create and maintain a database containing patients who have a history of ARF/RHD who have received ongoing treatment with prophylactic penicillin.
• Increase coverage of heart valve surgery (VS) through creating a surgical center or sending patients to other countries.

Researchers said that the tool is not a strict guide to follow, but more of a suggestion of potential treatments, since it relies on assumptions and uncertainties. The researchers discovered that RHD prevention is more cost-effective than treatment, and PP was most cost-effective in the long-term for the hypothetical country.

Sending patients abroad for VS could also be more cost-effective than building a new surgical center. They suggest initially investing in PP and SP prior to moving to VS, according to the study.

However, PP would cost approximately $847,000 for the hypothetical population, and may not be the most affordable option, although it saves money in the long-term through reducing ARF and avoiding the related costs. Researchers do not predict that SP and VS would be cost-saving measures.

The results largely depend on the number of cases, and the rate of progression from ARF to RHD. Researchers added that studies about disease prevalence and costs for treatments are needed.

They based their data heavily on extrapolations of costs from other countries, according to the study. Therefore, data users would need to collect their own data for the most accurate use of the tool.

Researchers note that low-income countries should prioritize the most effective and less costly interventions to make the most of their resources. For example, PP would be the most effective and inexpensive treatment, making it a first-priority intervention, the study concluded.