A Cost Analysis of Rheumatic Fever Management in Jamaica, 2012  to 2018

Authors

Background

Introduction: Jamaica’s burden of Acute Rheumatic Fever (ARF) and sequelae like Rheumatic Heart Disease (RHD)

have declined significantly since introduction of the WHO prevention programme in 1984 and has resulted in

reduced expenditure in prevention and control. This research aims to determine direct costs of Rheumatic Fever

(RF) events, compare them to expenditures recorded in the literature, and assess recommendations for investment

and prioritization.

Methods

A national cross-sectional survey was conducted to estimate inpatient, outpatient and prevention costs for each of

four RF groups (ARF, RHD with and without heart Failure, and Carditis). Medical records were accessed for all

patients recorded in the Hospital Active Surveillance Registries (2012 to 2018) from five major regional and

specialist hospitals. Relevant data were abstracted using an internally developed, pretested tool. Categorical costs

were calculated using the average number of units used per sub-category (e.g. registration, room and board,

consumables, tests, medications) and multiplied by National Health Service fees.

Conclusion

From 156 reports of ARF/RHD, 74 patients were identified as suspected or confirmed, of which 44 had demographic

information: 58.1% were male, and onset of ARF and RHD respectively were at 11.5 (SD 6.9) and 20.8 (SD 12.3)

years. The direct country cost of care was US$78,249.88 annually, averaged across all RF/RHD clients. The single

most costly component was inpatient admission, of which RHD, then ARF/Recurrent RF were costliest at US$695.30

and US$605.28 respectively. Secondary prophylaxis costs US$56.42/patient/year (US$36,189.16 nationally/year)

in optimal circumstances, and US$49.12 at the actual 67% compliance rate. At US$4.78/case, the annual cost of

pharyngitis management for at-risk 0-15 years olds was US$159,377.11.

Interpretation

Previous local data suggests that the total cost of care of RF conditions has fallen significantly since prevention

programme initiation. Adjusted for government subsidy, Jamaica’s direct ARF inpatient costs (US$2,421.12) are

comparable to the WHO-CHOICE inpatient estimate (US$2,225.57). These further approximate if local meal costs

are excluded as CHOICE estimates do. We believe the changing epidemiology of RF warrants prioritization for pre

and peri-natal RHD care, compliance boosting activities for prophylaxis, and clinical decision rules with rapid

antigen detection tests for targeted point of care diagnosis, all in keeping with global recommendations.