{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:58:51Z","timestamp":1789707531886,"version":"4.0.1"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Acute rheumatic fever and subsequent rheumatic heart disease remain significant in developing countries. We describe a cost-effective analysis of 7 strategies for the primary prevention of acute rheumatic fever and rheumatic heart disease in children presenting with pharyngitis in urban primary care clinics in South Africa.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We used a Markov model to assess the cost-effectiveness of treatment with intramuscular penicillin using each of the following strategies: (1) empirical (treat all); (2) positive throat culture (culture all); (3) clinical decision rule (CDR) score \u22652 (CDR 2+); (4) CDR score \u22653 (CDR 3+); (5) treating those with a CDR score \u22652 plus those with CDR score &lt;2 and positive cultures (CDR 2+, culture CDR negatives); (6) treating those with a CDR score \u22653 plus those with CDR score &lt;3 and positive cultures (CDR 3+, culture CDR negatives); and (7) treat none. The strategies ranked in order from lowest cost were treat all ($11.19 per child), CDR 2+ ($11.20); the CDR 3+ ($13.00); CDR 2+, culture CDR negatives ($16.42); CDR 3+, culture CDR negatives ($23.89); and culture all ($27.21). The CDR 2+ is the preferred strategy at less than $150\/quality-adjusted life year compared with the treat all strategy. A strategy of culturing all children compared with the CDR 2+ strategy costs more than $125 000\/quality-adjusted life year gained.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Treating all children presenting with pharyngitis in urban primary care clinics in South Africa with intramuscular penicillin is the least costly. A strategy of using a clinical decision rule without culturing is overall the preferred strategy. A strategy of culturing all children may be prohibitively expensive.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.111.000032","type":"journal-article","created":{"date-parts":[[2013,5,8]],"date-time":"2013-05-08T05:42:03Z","timestamp":1367991723000},"page":"343-351","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":63,"title":["Primary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease With Penicillin in South African Children With Pharyngitis"],"prefix":"10.1161","volume":"6","author":[{"given":"James","family":"Irlam","sequence":"first","affiliation":[{"name":"From the Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (J.I.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (B.M.M., M.E.); and Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (T.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bongani M.","family":"Mayosi","sequence":"additional","affiliation":[{"name":"From the Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (J.I.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (B.M.M., M.E.); and Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (T.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Engel","sequence":"additional","affiliation":[{"name":"From the Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (J.I.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (B.M.M., M.E.); and Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (T.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Gaziano","sequence":"additional","affiliation":[{"name":"From the Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (J.I.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (B.M.M., M.E.); and Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (T.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66874-2"},{"key":"e_1_3_3_3_2","first-page":"485","volume-title":"Rheumatic Fever","author":"Michaud C","year":"1999","unstructured":"Michaud C, Rammohan R, Narula J. 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