{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:52:27Z","timestamp":1753887147973,"version":"3.41.2"},"reference-count":71,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,6,3]]},"abstract":"<jats:sec id=\"jah310945-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">One\u2010third of the global rheumatic heart disease burden lies in sub\u2010Saharan Africa, where 17% of patients with severe rheumatic heart disease die within 3\u2009years without valve surgery. Surgery is often considered uneconomical, although this assumption is not grounded in cost\u2010effectiveness analyses.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310945-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We evaluated the cost\u2010effectiveness of mechanical valve replacement, bioprosthetic valve replacement, and valve repair compared with medical management for patients with severe rheumatic heart disease in Rwanda. Using a Markov model, we simulated disease progression, incorporating transition probabilities from a meta\u2010analysis of regional observational studies. Costs were calculated using microcosting, and health effects were measured in disability\u2010adjusted life\u2010years (DALYs). Cost\u2010effectiveness was defined by a willingness\u2010to\u2010pay threshold of United States dollars (USD) $2307 per DALY, which is 3 times Rwanda's gross domestic product per capita. A 3% discount rate for costs and DALYs was applied.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310945-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Surgical strategies extended life expectancy from 7 to 11 to 13\u2009years. Mechanical and bioprosthetic valve replacements were cost\u2010effective compared with medical management. Mechanical valve replacement was most efficient, averting 5.64 discounted DALYs for a lifetime discounted cost of USD $10 539.34, with an incremental cost\u2010effectiveness ratio of USD $1704 per DALY. Bioprosthetic valve replacement averted 5.27 discounted DALYs but incurred higher costs (USD $10 873.06). Valve repair only averted 3.30 DALYs despite being least expensive (USD $8790.19). Repair became the most efficient surgical strategy if valve degeneration rates dropped &lt;3.7% annually.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310945-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Mechanical valve replacement is the most efficient surgical strategy for severe rheumatic heart disease in sub\u2010Saharan Africa, challenging assumptions that surgery is uneconomical. Reducing surgery costs and optimizing anticoagulation could further enhance cost\u2010effectiveness.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.038365","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T10:08:17Z","timestamp":1748254097000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness Analysis of Surgical Strategies Versus Medical Management for Rheumatic Heart Disease in Rwanda"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3468-7018","authenticated-orcid":false,"given":"Vongai","family":"Mlambo","sequence":"first","affiliation":[{"name":"Stanford University","place":["Stanford"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Songnan","family":"Wang","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Stanford"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurice","family":"Musoni","sequence":"additional","affiliation":[{"name":"King Faisal Hospital","place":["Kigali, Rwanda"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6592-930X","authenticated-orcid":false,"given":"Hannah","family":"Rando","sequence":"additional","affiliation":[{"name":"University of Vermont Medical Center","place":["Burlington"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1094-1715","authenticated-orcid":false,"given":"Lambert","family":"Ingabire","sequence":"additional","affiliation":[{"name":"King Faisal Hospital","place":["Kigali, Rwanda"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6073-6966","authenticated-orcid":false,"given":"Ceeya","family":"Patton\u2010Bolman","sequence":"additional","affiliation":[{"name":"Team Heart","place":["Kigali, Rwanda"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Mukeshimana","sequence":"additional","affiliation":[{"name":"King Faisal Hospital","place":["Kigali, Rwanda"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5091-9719","authenticated-orcid":false,"given":"Evariste","family":"Ntaganda","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center","place":["Kigali, Rwanda"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8824-9921","authenticated-orcid":false,"given":"Ralph","family":"Bolman","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eran","family":"Bendavid","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Stanford"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1704-8057","authenticated-orcid":false,"given":"Yihan","family":"Lin","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Stanford"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","volume-title":"Global Burden of Disease Study 2021 (GBD 2021)","author":"Global Burden of Disease Collaborative Network","year":"2024","unstructured":"Global Burden of Disease Collaborative Network . 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