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Thangamma Ag M, Vidyadharan B, Daniel RP, Sirur A, Kumar P, Thunga P G, Gopal Poojari P, Rashid M, Mukherjee N, Bhattacharya P, John D. Cost and cost-effectiveness of treatments for rheumatic heart disease in low- and middle-income countries: a systematic review protocol. JBI Evid Synth 2024; 22:1886-1897. [PMID: 38932504 DOI: 10.11124/jbies-23-00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This review will synthesize studies on costs, the impact of these costs, and the cost-effectiveness of treatments for rheumatic heart disease (RHD) in low- and middle-income countries. INTRODUCTION RHD incurs high costs owing to its clinical complexity, surgical treatments, and prolonged hospital stays. Thus, the disease has a substantial economic impact on the health system, patients, and their families. No systematic review on economic evidence of treatments for RHD has been published to date. INCLUSION CRITERIA This review will consider all cost and cost-effectiveness studies on RHD treatments for children and young adults (5─30 years) residing in low- and middle-income countries. METHODS The review will follow the JBI methodology for systematic reviews of economic evaluation evidence. The search strategy will locate published and unpublished studies in English. Systematic searches will be conducted in MEDLINE (PubMed), MEDLINE (Ovid), Embase (Ovid), Scopus, CINAHL (EBSCOhost), National Health Service Economic Evaluation Databases, Pediatric Economic Database Evaluation, and Cost-Effectiveness Analysis Registry. Two independent reviewers will screen titles and abstracts, followed by a full-text review based on the inclusion criteria. Data will be extracted using a modified JBI data extraction form for economic evaluations. JBI's Dominance Ranking Matrix for economic evaluations will be used to summarize and compare the results of cost and cost-effectiveness studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of economic evidence for outcomes related to resource use. REVIEW REGISTRATION PROSPERO CRD42023425850.
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Affiliation(s)
- Mona Thangamma Ag
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavya Vidyadharan
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Roshan P Daniel
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Andria Sirur
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga P
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nirmalya Mukherjee
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Paramita Bhattacharya
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda, Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Denny John
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda, Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
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Soesanto AM, Rudiktyo E, Tjubandi A, Ariani R, Azzahra FN, Adam MF, Kuncoro AS. Clinical Outcome of Rheumatic Mitral Valve Repair and Replacement Surgery in Indonesia; A Comparison with Non-Rheumatic Aetiology. Glob Heart 2024; 19:4. [PMID: 38222099 PMCID: PMC10786046 DOI: 10.5334/gh.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Mitral valve repair (MVr) has been shown to achieve better outcomes than mitral valve replacement (MVR) in degenerative aetiology. However, that cannot be applied in rheumatic mitral valve disease. Therefore, this study aims to evaluate early and late clinical outcomes and mid-term survival in RHD compared to the non-RHD group and whether mitral valve repair is a better surgical approach in RHD patients. Methods Patients who underwent mitral valve surgery with or without coronary artery bypass grafting were included in this study. All patients were divided into the RHD and non-RHD group by the type of mitral surgery performed. Early and late outcomes were evaluated, and mid-term cumulative survival was reported. Results A total of 1382 patients post MV surgeries were included. The 30-day mortality was significantly higher in the RHD group compared to the non-RHD group (8.7% vs. 4.4%, p = 0.003). There was no difference in 30-day mortality between repair and replacement in each respective group. During follow-up (12-54 months), all-cause mortality between RHD and non-RHD groups (16.7% vs. 16.2%) was not different. In the RHD group, the survival of MVr was 85.6% (95% CI 82.0%-88.5%), and MVR was 78.3% (95% CI 75.8%-80.6%), p-value log rank 0.26 However, in the non-RHD group, patients who underwent MVr had better survival than MVR, with cumulative survival of 81.7% (95% CI 72.3%-88.2%) vs. 71.1% (95% CI 56.3%-81.7%) p-value log rank 0.007. Conclusion Early mortality rate in rheumatic mitral valve surgery was higher than in non-rheumatic valve surgery. Although in rheumatic MV disease MV repair did not show a significant survival advantage over MV replacement, a trend towards more favourable survival in the repair group was observed.
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Affiliation(s)
- Amiliana Mardiani Soesanto
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Estu Rudiktyo
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Amin Tjubandi
- Adult Cardiac Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Rina Ariani
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | | | - Mochammad Faisal Adam
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Ario Soeryo Kuncoro
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
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Cannon JW, Wyber R. Modalities of group A streptococcal prevention and treatment and their economic justification. NPJ Vaccines 2023; 8:59. [PMID: 37087467 PMCID: PMC10122086 DOI: 10.1038/s41541-023-00649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/23/2023] [Indexed: 04/24/2023] Open
Abstract
Infection by group A Streptococcus (Strep A) results in a diverse range of clinical conditions, including pharyngitis, impetigo, cellulitis, necrotising fasciitis, and rheumatic heart disease. In this article, we outline the recommended strategies for Strep A treatment and prevention and review the literature for economic evaluations of competing treatment and prevention strategies. We find that most economic evaluations focus on reducing the duration of illness or risk of rheumatic fever among people presenting with sore throat through diagnostic and/or treatment strategies. Few studies have evaluated strategies to reduce the burden of Strep A infection among the general population, nor have they considered the local capacity to finance and implement strategies. Evaluation of validated costs and consequences for a more diverse range of Strep A interventions are needed to ensure policies maximise patient outcomes under budget constraints. This should include attention to basic public health strategies and emerging strategies such as vaccination.
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Affiliation(s)
- Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Rosemary Wyber
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, ANU College of Health & Medicine, The Australian National University, Canberra, Australia
- Adjunct Senior Research Fellow, University of Western Australia, Nedlands, WA, Australia
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Ubels J. Saving money, saving lives: Health economics as a guide to cost-effective decision making. Int J Cardiol 2021; 339:130-131. [PMID: 34216709 DOI: 10.1016/j.ijcard.2021.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jasper Ubels
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.
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