Table 6.
Clinical Outcomes and Cost–Utility Analysis of Improving BPG Adherence With and Without Screening
| No Screen | Screena | |||
|---|---|---|---|---|
| Current Progression (50% BPG) | Improved Progressionb (100% BPG) | Current Progression (50% BPG) | Improved Progressionb (100% BPG) | |
| Clinical outcomes | ||||
| RHD severity at diagnosis | ||||
| Mild, % | 59.5 | 59.5 | 67.2 | 67.2 |
| Moderate, % | 27.1 | 27.1 | 25.0 | 25.0 |
| Severe, % | 13.4 | 13.4 | 7.8 | 7.8 |
| Heart failure at any time, % | 37.7 | 18.9 | 33.5 | 12.9 |
| Surgery, % | 31.1 | 15.2 | 27.6 | 10.4 |
| Death, % | 11.3 | 6.5 | 9.9 | 4.6 |
| Cost–utility analysis | ||||
| Number of diagnoses | 138 | 138 | 164 | 164 |
| Mean cost per diagnosis (AU$,000) | 49.6 | 51.3 | 55.5 | 55.6 |
| RHD screening cost | ··· | ··· | 14.8 | 14.8 |
| RHD management cost | 49.6 | 51.3 | 40.7 | 40.8 |
| Mean utility per diagnosis (DALY) | 1.33 | 0.86 | 1.21 | 0.69 |
| ICER (AU$/DALY saved)c | ··· | 3463c | 47 546c | 9329c |
BPG indicates benzathine penicillin G; DALY, disability‐adjusted life‐year; ICER, incremental cost‐effectiveness ratio; RHD, rheumatic heart disease.
a
Echo B, scenario 2.
b
Improved progression assumes mild disease does not progress; half of the moderate disease that currently progresses to severe will not progress; all other transitions remain the same.
c
Compared with current progression in the no‐screen cohort.