n South African Medical Journal - Primary prevention of rheumatic fever in children : key factors to consider : correspondence

Volume 104, Issue 3
  • ISSN : 0256-9574
  • E-ISSN: 2078-5135



We applaud the efforts by Irlam et al. to conduct a cost-effectiveness analysis of primary prevention of rheumatic fever (RF) in children. The authors used a Markov decision analysis cohort model to assess seven different treatment strategies for children presenting with sore throat. A particular strength of the study was the inclusion of costs relating to secondary prevention and development of chronic rheumatic heart disease (RHD). The authors concluded that using clinical criteria for the diagnosis of pharyngitis without culturing for group A streptococci is the most cost-effective intervention for the prevention of RF and RHD in settings where these diseases are endemic. However, we believe that they have not fully considered several important issues.

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