Cost-Effectiveness of Echocardiographic Screening of School-Age Children in India for Rheumatic Heart Disease:
Rheumatic heart disease (RHD) has long sat in a public health blind spot because policy makers underappreciate the enormous economic burden of the disability and premature mortality it places on the world’s poorest nations. Secondary prophylaxis with penicillin is effective and strongly recommended by the World Health Organization, but the optimal screening method to identify who should receive secondary prophylaxis is unclear. Recent studies have shown that echocardiography identifies 10-20 fold more cases than physical examination alone, resulting in calls for national echocardiographic screening programs. But echocardiography is expensive and technically demanding, and its cost-effectiveness as a public health intervention remains undefined. The RAP Global Health Policy Award will support a partnership between UCSF and Indian collaborators to systematically evaluate whether echocardiographic screening programs represent a sound public health investment. In order to answer that question, we are building the India RHD Policy Model: a microsimulation model recreating the natural history of RHD to assess the cost-effectiveness of echocardiographic screening of school-age children in India. This is a timely endeavor as India and other low- and middle-income countries (LMICs) direct greater attention and funding to their ongoing epidemics of non-communicable diseases. The India RHD Policy Model will produce actionable, policy-relevant results; be adaptable to other contexts (e.g., Sub-Saharan Africa); and extendible to evaluate other prevention strategies for RHD control. On account of RHD’s position at the interfacebetween communicable and non-communicable diseases, strategies for RHD control may serve as aroadmap for public health interventions in LMICs undergoing the epidemiological transition. We thank RAP and Global Health Sciences for supporting this international collaboration.