Related Experiment Video
Updated: Mar 6, 2026
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost-Utility Analysis
Kathryn Roberts1, Jeffrey Cannon2, David Atkinson3
1Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.
Insights
Echocardiographic screening for rheumatic heart disease (RHD) in Indigenous Australian children is cost-effective if RHD is detected at least two years earlier. Combining screening with improved secondary prophylaxis further reduces heart failure, surgery, and death.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- Rheumatic heart disease (RHD) disproportionately affects children and young adults in disadvantaged populations, causing significant cardiovascular morbidity and mortality.
- Echocardiographic screening offers a promising avenue for early RHD detection and intervention.
- Indigenous Australian children are particularly vulnerable to RHD, necessitating targeted public health strategies.
Purpose of the Study:
- To conduct a cost-utility analysis of echocardiographic screening for RHD in Indigenous Australian children.
- To inform policy decisions regarding RHD screening in Australia.
- To develop an adaptable model for RHD screening cost-effectiveness analysis in other global settings.
Main Methods:
- Utilized a multistate model of RHD progression based on Australian RHD register data.
- Simulated two screening strategies, varying the early detection window (1, 2, or 3 years).
- Assessed outcomes including heart failure, surgery, mortality, disability-adjusted life-years (DALYs), and costs.
Main Results:
- A cost-effective strategy involved screening Indigenous children aged 5-12 in half their communities every other year, with an incremental cost-effectiveness ratio (ICER) under AU$50,000 per DALY averted, contingent on ≥2 years of early detection.
- This cost-effectiveness finding was sensitive to underlying assumptions.
- Improved adherence to secondary prophylaxis alone significantly reduced RHD-related adverse events, with further improvements observed when combined with screening.
Conclusions:
- Echocardiographic screening for RHD is a cost-effective intervention in the studied context, provided it enables detection at least two years earlier.
- The developed model is adaptable for use in other settings, requiring local data or validated assumptions for parameterization.
- Integrating screening with enhanced secondary prophylaxis offers a powerful dual approach to mitigate RHD's impact.
Background:
Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and mortality in children and young adults in disadvantaged populations. The emergence of echocardiographic screening provides the opportunity for early disease detection and intervention. Using our own multistate model of RHD progression derived from Australian RHD register data, we performed a cost-utility analysis of echocardiographic screening in indigenous Australian children, with the dual aims of informing policy decisions in Australia and providing a model that could be adapted in other countries.
Methods And Results:
We simulated the outcomes of 2 screening strategies, assuming that RHD could be detected 1, 2, or 3 years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability-adjusted life-years, and corresponding costs. Only a strategy of screening all indigenous 5- to 12-year-olds in half of their communities in alternate years was found to be cost-effective (incremental cost-effectiveness ratio less than AU$50 000 per disability-adjusted life-year averted), assuming that RHD can be detected at least 2 years earlier by screening; however, this result was sensitive to a number of assumptions. Additional modeling of improved adherence to secondary prophylaxis alone resulted in dramatic reductions in heart failure, surgery, and death; these outcomes improved even further when combined with screening.
Conclusions:
Echocardiographic screening for RHD is cost-effective in our context, assuming that RHD can be detected ≥2 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:21Rheumatic Heart Disease III: Medical Management
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:23Rheumatic Heart Disease I: Introduction
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests