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The economic impact of rheumatic heart disease in developing countries

  • March 2015
  • The Lancet Global Health 3(S1):S37
DOI:10.1016/S2214-109X(15)70156-7
Authors:
Dr D Watkins
Dr D Watkins
Dr D Watkins
  • This person is not on ResearchGate, or hasn't claimed this research yet.
A Daskalakis
A Daskalakis
A Daskalakis
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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Abstract

Rheumatic heart disease (RHD) is a neglected disease of poverty that is the most common paediatric cardiovascular condition in developing countries. Most RHD deaths occur in children and working-age adults, in whom the economic impact of premature death is high. Despite RHD being a preventable disease, global research and development funding for RHD was recently estimated at US$1·7 million, or about 0·1% of all global health funding. Decisions to scale up costly medical and surgical interventions for RHD are hindered, in part, by lack of evidence for the so-called return on investment that could be achieved through prevention of RHD-related mortality. We conducted a modelling study using data from 107 countries to estimate the economic impact of excess mortality from RHD.
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37
The economic impact of rheumatic heart disease in
developing countries
D Watkins, A Daskalakis
Abstract
Background Rheumatic heart disease (RHD) is a neglected disease of poverty that is the most common paediatric
cardiovascular condition in developing countries. Most RHD deaths occur in children and working-age adults,
in whom the economic impact of premature death is high. Despite RHD being a preventable disease, global research
and development funding for RHD was recently estimated at US$1·7 million, or about 0·1% of all global health
funding. Decisions to scale up costly medical and surgical interventions for RHD are hindered, in part, by lack
of evidence for the so-called return on investment that could be achieved through prevention of RHD-related mortality.
We conducted a modelling study using data from 107 countries to estimate the economic impact of excess mortality
from RHD.
Methods We used the full income approach to quantify the economic losses from RHD in 107 countries where the
disease is endemic during 2010. Our analysis synthesised data from the Global B
urden of Disease 2010 study, WHO
life tables, UN population estimates, and World Bank macroeconomic indicators such as gross domestic product
(GDP) per capita that are used in full-income calculations. We used the RHD mortality pattern in Costa Rica in 2010
as a baseline from which to defi ne excess mortality. Data from this country were used because of Costa Rica’s
demonstrated success in controlling RHD in previous decades as well as its health system’s resilience under political
and economic constraints. We reported costs discounted at 3% yearly as well as undiscounted.
Findings We noted that the cost of the approximately 222 000 excess deaths from RHD in 2010 was around
US$ (2014) 2·2 trillion (discounted) or US$5·4 trillion (undiscounted). M
ost of the economic burden of RHD was in
countries with large populations in south Asia and east Asia. Our estimates were roughly proportional to those reported
in a full-income study of HIV/AIDS mortality in sub-Saharan Africa, although our estimates were 10–100 times higher
than those obtained using other economic methods, such as multiples of GDP per capita per disability-adjusted life-
year.
Interpretation RHD continues to exert massive economic eff
ects globally
, mainly because of premature death
in children and working-age adults. The economic cost of RHD in developing countries is over a million times higher
than current donor funding levels. Our estimates suggest that careful increases in public-sector and private-sector
spending on eff ective RHD prevention and control measures could provide impressive returns on investment. Future
work will compare the full-income results to other economic evaluation methods such as those recommended by the
Commission on Macroeconomics and Health. Our results could be the basis for benefi t-cost analyses of medical and
surgical interventions in resource-limited countries.
Funding None.
Copyright © Watkins et al. Open Access article distributed under the terms of CC BY.
Declaration of interests
We declare no competing interests.
Published Online
March 26, 2015
University of W
ashington,
Seattle, WA, USA
(D Watkins MD); and Global
Heart Network Foundation,
San Francisco, CA, USA
(A Daskalakis BS)
Correspondence to:
Dr David A Watkins, Division
of General Internal Medicine,
University of Washington,
Seattle, WA, USA.
davidaw@uw.edu
... The costs of the 222,000 lives lost because of RHD in 2010, mainly originating from South and East Asia, were estimated to range between US$2.2 trillion and US$5.4 trillion. Most of the economic impact of RHD is due to the premature death of children and working-age adults [45]. ...
Application of Transthoracic Echocardiography for Cardiac Safety Evaluation in the Clinical Development Process of Vaccines Against Streptococcus pyogenes
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... It is a serious public health problem especially in low and middle income countries with limited capacities for the diagnosis and timely management of streptococcal infection [5]. It exerts massive economic effects globally, mainly because of premature death in children and workingage adults [7]. Globally, ARF and RHD are seen in developing nations or among disadvantaged populations within developed nations [8]. ...
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... Continuation of prescribed medication and proper medical treatment should be encouraged at all times. Discontinuation of antihypertensive pharmacotherapy due to the fear of angiotensin-converting enzyme inhibitors (ACEI) favoring virus infection (Figures 1 and 2) [14][15][16][17][18] is not recommended as the risk-bene t ratio associated with the use of ACEIs and angiotensin II receptor blockers (ARBs) suggests bene ts in their maintenance [19,20]. ...
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The COVID-19 pandemic has significantly impacted cardiovascular disease, particularly rheumatic heart disease (RHD). Importantly, RHD has been shown to be a significant risk factor for the prognosis of COVID-19, with severe valvular heart disease leading to poorer clinical outcomes of COVID-19 infection. Regardless, interest and prioritization of RHD in the world agenda remain low, even after the pandemic. Medical appointments, compliance with medical treatment, and prophylaxis should be encouraged. Prioritization of RHD research and efforts to improve diagnosis, treatment, prevention, and care are warranted.
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... RHD can cause considerable valvular damage, which may lead to major cardiac morbidity and premature mortality [8]. Because RHD predominately affects the relatively young, the disease could impose an enormous economic burden (direct and indirect) on the families of those affected and on society in general [9]. ...
The burden of rheumatic heart disease in the Middle-East and North-Africa region, 1990−2019
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  • Oct 2023
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Abstract Background: Rheumatic heart disease (RHD) is a treatable and preventable condition resulting from acute rheumatic fever. Aim: To report the prevalence, mortality and disability-adjusted life-years (DALY) due to RHD in the Middle-East and North-Africa (MENA) region from 1990 to 2019, by sex, age group, country and sociodemographic index (SDI). Methods: Information on the prevalence, mortality and DALY associated with RHD was obtained from the Global Burden of Disease Study 2019. Data were gathered for all countries in the MENA region over the period 1990−2019. These data included counts and age-standardized rates per 100,000, accompanied by 95% uncertainty intervals (UIs). Results: The MENA region had an age-standardized point prevalence of 388.9 per 100,000 in 2019, which was 5.4% higher than in 1990. The annual incidence rate was 1.6, which was 63.4% lower than in 1990. There were 379.4 thousand DALY attributable to RHD in 2019, with an age-standardized rate of 67.1, which was 61.3% lower than in 1990. In 2019, an estimated 7.4 thousand deaths were due to RHD, and the age-standardized death rate was 63.4% lower in 2019 than in 1990. DALY rates rose steadily with increasing age in both males and females. The SDI correlated negatively with the rate of DALY for RHD throughout the study period. Conclusion: The burden of RHD in MENA declined from 1990 to 2019, demonstrating the importance of regularly updating health data and identifying risk factors, and developing effective guidelines on prevention.
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... Additionally, recent studies have described the near-atrocious economic impact of RHD at the household, health system, and national level in endemic countries such as Uganda [218], South Africa [219,220], India [221,222], and others [223]. ...
Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum
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Full-text available
  • Jan 2022
Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from the developed world, the disease remains endemic in many low- and middle-income countries (LMICs), with grim health and socioeconomic impacts. The neglect of RHD which persisted for a semi-centennial was further driven by competing infectious diseases, particularly the human immunodeficiency virus (HIV) pandemic. However, over the last two-decades, slowly at first but with building momentum, there has been a resurgence of interest in RF/RHD. In this narrative review, we present the advances that have been made in the RF/RHD continuum over the past two decades since the re-awakening of interest, with a more concise focus on the last decade’s achievements. Such primary advances include understanding the genetic predisposition to RHD, group A Streptococcus (GAS) vaccine development, and improved diagnostic strategies for GAS pharyngitis. Echocardiographic screening for RHD has been a major advance which has unearthed the prevailing high burden of RHD and the recent demonstration of benefit of secondary antibiotic prophylaxis on halting progression of latent RHD is a major step forward. Multiple befitting advances in tertiary management of RHD have also been realized. Finally, we summarize the research gaps and provide illumination on profitable future directions towards global eradication of RHD.
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... Yet, the compelling need to redress the neglect of RHD and RHD-P in public health and funding arenas persists. Even ignoring the critical social justice issues of RF/RHD, its associated fiscal burden demands significantly better support [75][76][77]: it costs USD5 to treat a sore throat, compared to the lifetime burden associated with valvular surgery upwards of USD29,000 [56,62,78,79]. The maternal and perinatal costs of the burden of RHD are exponentially higher [80], particularly when the indirect costs of economic impact are taken into account -family, community, work -are taken into account. ...
Rheumatic Heart Disease in Pregnancy: New Strategies for an Old Disease?
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Full-text available
  • Dec 2021
RHD in pregnancy (RHD-P) is associated with an increased burden of maternal and perinatal morbidity and mortality. A sequellae of rheumatic fever resulting in heart valve damage if untreated, RHD is twice as common in women. In providing an historical overview, this commentary provides context for prevention and treatment in the 21 st century. Four underlying themes inform much of the literature on RHD-P: its association with inequities; often-complex care requirements; demands for integrated care models, and a life-course approach. While there have been some gains particularly in awareness, strengthened policies and funding strategies are required to sustain improvements in the RHD landscape and consequently improve outcomes. As the principal heart disease seen in pregnant women in endemic regions, it is unlikely that the Sustainable Development Goal 3 target of reduced global maternal mortality ratio can be met by 2030 if RHD is not better addressed for women and girls.
View
... Another study showed that RHD causes massive economic effects worldwide due to the premature death of young and working-age adults. It is estimated to cause a 2.2 trillion-dollar loss worldwide annually [29]. ...
Rheumatic Heart Disease is Missing from the Global Health Agenda
Article
Full-text available
  • Nov 2021
Rheumatic heart disease (RHD) is a complication of untreated throat infection by Group A beta-hemolytic streptococcus with a high prevalence among socioeconomically disadvantaged populations. Despite its high incidence and prevalence, RHD prevention is not a priority in major global health discussions. The reasons for the apparent neglect are multifactorial, including underestimated morbidity and mortality burden, underappreciated economic burden, lack of public awareness, and lack of sustainable investment. In this review, we recommend multisectoral collaboration to tackle the burden of RHD by engaging the public, health experts, and policymakers; augmenting funding for clinical care; improving distribution channels for prophylaxis, and increasing research and innovation as critical interventions to save millions of people from preventable morbidity and mortality.
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Period Prevalence of Rheumatic Heart Disease and the Need for a Centralized Patient Registry in American Samoa, 2016 to 2018
Article
Full-text available
  • Oct 2021
Background Rheumatic heart disease (RHD) is a severe, chronic complication of acute rheumatic fever, triggered by group A streptococcal pharyngitis. Centralized patient registries are recommended for RHD prevention and control, but none exists in American Samoa. Using existing RHD tracking systems, we estimated RHD period prevalence and the proportion of people with RHD documented in the electronic health record. Methods and Results RHD cases were identified from a centralized electronic health record system, which retrieved clinical encounters with RHD International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) codes, clinical problem lists referencing RHD, and antibiotic prophylaxis administration records; 3 RHD patient tracking spreadsheets; and an all‐cause mortality database. RHD cases had ≥1 clinical encounter with RHD ICD‐10‐CM codes, a diagnostic echocardiogram, or RHD as a cause of death, or were included in RHD patient tracking spreadsheets. Period prevalence per 1000 population among children aged <18 years and adults aged ≥18 years from 2016 to 2018 and the proportion of people with RHD with ≥1 clinical encounter with an RHD ICD‐10‐CM code were estimated. From 2016 to 2018, RHD was documented in 327 people (57.2%: children aged <18 years). Overall RHD period prevalence was 6.3 cases per 1000 and varied by age (10.0 pediatric cases and 4.3 adult cases per 1000). Only 67% of people with RHD had ≥1 clinical encounter with an RHD ICD‐10‐CM code. Conclusions RHD remains a serious public health problem in American Samoa, and the existing electronic health record does not include all cases. A centralized patient registry could improve tracking people with RHD to ensure they receive necessary care.
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