{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T19:18:52Z","timestamp":1784747932090,"version":"3.55.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec xml:lang=\"en\"><jats:title>Background<\/jats:title><jats:p xml:lang=\"en\">Rheumatic heart disease (<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>) 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<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>progression derived from Australian<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>register data, we performed a cost\u2013utility 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.<\/jats:p><\/jats:sec><jats:sec xml:lang=\"en\"><jats:title>Methods and Results<\/jats:title><jats:p xml:lang=\"en\">We simulated the outcomes of 2 screening strategies, assuming that<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>could be detected 1, 2, or 3\u00a0years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability\u2010adjusted life\u2010years, and corresponding costs. Only a strategy of screening all indigenous 5\u2010 to 12\u2010year\u2010olds in half of their communities in alternate years was found to be cost\u2010effective (incremental cost\u2010effectiveness ratio less than AU$50\u00a0000 per disability\u2010adjusted life\u2010year averted), assuming that<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>can be detected at least 2\u00a0years 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.<\/jats:p><\/jats:sec><jats:sec xml:lang=\"en\"><jats:title>Conclusions<\/jats:title><jats:p xml:lang=\"en\">Echocardiographic screening for<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>is cost\u2010effective in our context, assuming that<jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>can be detected \u22652 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.<\/jats:p><\/jats:sec>","DOI":"10.1161\/jaha.116.004515","type":"journal-article","created":{"date-parts":[[2017,3,3]],"date-time":"2017-03-03T02:10:51Z","timestamp":1488507051000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost\u2013Utility Analysis"],"prefix":"10.1161","volume":"6","author":[{"given":"Kathryn","family":"Roberts","sequence":"first","affiliation":[{"name":"Menzies School of Health Research Royal Darwin Hospital Campus Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Cannon","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute The University of Western Australia Subiaco Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Rural Clinical School of Western Australia University of Western Australia Broome Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Brown","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme","family":"Maguire","sequence":"additional","affiliation":[{"name":"Baker IDI Heart and Diabetes Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Remenyi","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Royal Darwin Hospital Campus Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Wheaton","sequence":"additional","affiliation":[{"name":"Women's and Children's Hospital Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Geelhoed","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute The University of Western Australia Subiaco Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute The University of Western Australia Subiaco Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"World Health Organization . 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