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Preventing and Controlling Rheumatic Heart Disease in Namibian children; Will a Prevention Programme be Cost Effective?: A Cost-Effectiveness Analysis by Markov Model
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: Rheumatic Heart Disease (RHD) remains a public health concern globally, with sub-Saharan Africa being the highest prevalent region. Posing a high burden of disease and economic implications, the disease is preventable. Recent mobilisation toward RHD eradication is promising. The proposed RHD national prevention programme, and introduction of a national advisory committee in Namibia increases the hopes for a more effective management of this highly prevalent disease in the country. However, affordability is always a concern to public health interventions, hence a need to examine the cost-effectiveness of this programme in Namibia. There also exists a gap in knowledge regarding cost-effectiveness of population-based, combined primary and secondary prevention strategies globally and locally.

Objectives: The study aims to explore the cost-effectiveness of a RHD prevention programme and inform appropriately policymaking regarding the disease.

Methods: A Markov model with five state states; healthy, group A Streptococcal pharyngitis, Rheumatic Fever, and RHD was developed for Namibian children, and modelled from a societal perspective over a lifetime horizon. Study inputs are extrapolated from the existing literature, and assumed by necessity. Health gains were estimated as quality adjusted life years (QALYs). The incremental cost-effectiveness ratios (ICERs) per QALY gained was calculated to show whether the programme is cost-effective compared to current spontaneous standard treatment. Cost-effectiveness acceptability threshold were defined buy one and three times per capita gross domestic product per QALY gained.

Results: We found that a combined primary and secondary prevention programme to control RHD is cost-effective compared to the standard treatment. Extra QALYs 1.95 gained, and an ICER of -$1 598.66 were observed, respectively.

Conclusion: A programme to prevent and control RHD will yield greater health benefits and cost-effective compared to current spontaneous treatment regimes. Yet, further research is needed to gather accurate local data to validly evaluate this effectiveness. Overall RHD research need to produce precise data on incidences, transitions, and costs to model this effectiveness most accurately.

Place, publisher, year, edition, pages
2017. , p. 23
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2017:37
Keywords [en]
RHD, ARF, GAS pharyngitis, Cost effectiveness, Markov model, incremental cost-effectiveness ratio
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-142732OAI: oai:DiVA.org:umu-142732DiVA, id: diva2:1164035
External cooperation
Dr Christopher Hugo- Hamman - Windhoek Central and Roman Catholic Hospitals, Namibia; Dr David A. Watkins - Harborview Medical Center.
Educational program
Master's Programme in Public Health
Presentation
2017-05-22, Room 933, 9th floor, Dentistry building, Umeå University Hospital, Umeå, 09:00 (English)
Supervisors
Examiners
Available from: 2017-12-19 Created: 2017-12-08 Last updated: 2017-12-19Bibliographically approved

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