Evaluating efficiency and equity of prevention and control strategies for rheumatic fever and rheumatic heart disease in India: an extended cost-effectiveness analysis

Dixit, J., Prinja, S., Jyani, G., Bahuguna, P. , Gupta, A., Vijayvergiya, R. and Kumar, R. (2023) Evaluating efficiency and equity of prevention and control strategies for rheumatic fever and rheumatic heart disease in India: an extended cost-effectiveness analysis. Lancet Global Health, 11(3), e445-e455. (doi: 10.1016/S2214-109X(22)00552-6) (PMID:36796988)

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Abstract

Background: There is a dearth of evidence on the cost-effectiveness of a combination of population-based primary, secondary, and tertiary prevention and control strategies for rheumatic fever and rheumatic heart disease. The present analysis evaluated the cost-effectiveness and distributional effect of primary, secondary, and tertiary interventions and their combinations for the prevention and control of rheumatic fever and rheumatic heart disease in India. Methods: A Markov model was constructed to estimate the lifetime costs and consequences among a hypothetical cohort of 5-year-old healthy children. Both health system costs and out-of-pocket expenditure (OOPE) were included. OOPE and health-related quality-of-life were assessed by interviewing 702 patients enrolled in a population-based rheumatic fever and rheumatic heart disease registry in India. Health consequences were measured in terms of life-years and quality-adjusted life-years (QALY) gained. Furthermore, an extended cost-effectiveness analysis was undertaken to assess the costs and outcomes across different wealth quartiles. All future costs and consequences were discounted at an annual rate of 3%. Findings: A combination of secondary and tertiary prevention strategies, which had an incremental cost of ₹23 051 (US$30) per QALY gained, was the most cost-effective strategy for the prevention and control of rheumatic fever and rheumatic heart disease in India. The number of rheumatic heart disease cases prevented among the population belonging to the poorest quartile (four cases per 1000) was four times higher than the richest quartile (one per 1000). Similarly, the reduction in OOPE after the intervention was higher among the poorest income group (29·8%) than among the richest income group (27·0%). Interpretation: The combined secondary and tertiary prevention and control strategy is the most cost-effective option for the management of rheumatic fever and rheumatic heart disease in India, and the benefits of public spending are likely to be accrued much more by those in the lowest income groups. The quantification of non-health gains provides strong evidence for informing policy decisions by efficient resource allocation on rheumatic fever and rheumatic heart disease prevention and control in India.

Item Type:Articles
Additional Information:Funding Department of Health Research, Ministry of Health and Family Welfare, New Delhi.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bahuguna, Dr Pankaj
Authors: Dixit, J., Prinja, S., Jyani, G., Bahuguna, P., Gupta, A., Vijayvergiya, R., and Kumar, R.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Lancet Global Health
Publisher:Elsevier
ISSN:2214-109X
ISSN (Online):2214-109X
Published Online:14 February 2023
Copyright Holders:Copyright © 2023 The Author(s)
First Published:First published in Lancet Global Health 11(3): e445-e455
Publisher Policy:Reproduced under a Creative Commons License

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