Figure 1
Graphical representation of the Markov model applied for the evaluation of systematic Rheumatic Heart Disease screening in Brazil.
Table 1
Costs per individual per state (in 2017 dollars).
| State | Cost | Source |
|---|---|---|
| Stata A: No RHD | 0 | – |
| State B: Undiagnosed Asymptomatic Borderline RHD | 0 | – |
| State C: Untreated Asymptomatic RHD | 0 | – |
| State D: Untreated Mild Clinical RHD | 0 | – |
| State E: Untreated Severe Clinical RHD | 0 | – |
| State F: Diagnosed Borderline RHD | $25.84 | DataSUS |
| State G: Treated Asymptomatic RHD | $93.93 | DataSUS |
| Stage H: Treated Mild Clinical RHD | $337.47 | DataSUS |
| State I: Treated Severe Clinical RHD | $854,00 | Ribeiro et al. [17] |
| State RG: Resolved RHD | $93.93 | Assumed to be equal to stage G |
| State RH: Resolved RHD | $337.47 | Assumed to be equal to state H |
| State RI: Resolved RHD | $854,00 | Assumed to be equal to state I |
| State K: Post Surgery | $854,00 | Ribeiro et al. [17] |
| State X: Surgery | $4,120.51 | dataSUS, based on disease codes from do Espirito Santo Freire et al. [33] |
| State Z: Death | 0 | – |
[i] Abbreviations: DataSUS: administrative database of the public health system (Unified Health System) in Brazil; RHD: Rheumatic Heart Disease.
Table 2
Results of the deterministic cost-effectiveness analysis.
| Parameter | Cost |
|---|---|
| Cost standard treatment | $34,249.72 |
| Cost intervention (screening) | $49,828.52 |
| DALY’s standard treatment | 726.63 |
| DALY’s intervention | 725.09 |
[i] Abbreviations: DALY: Disability-adjusted life years.
Figure 2
Cost-effectiveness acceptability curve. The X-axis shows a range of increasing cost-effectiveness thresholds, while the Y-axis shows how high the probability is that the screening intervention is cost-effective against a cost-effectiveness threshold when compared to standard care if variance in the data is taken into account. The line shows how high the probability is that the intervention is accepted against a certain cost-effectiveness threshold, given the uncertainty of the parameter estimates.
Figure 3
Sensitivity analysis applied to the cost-effectiveness model. The y-axis shows various parameters, while the x-axis shows a range of ICERs. The dotted line shows the ICER of the base model, while the solid line shows the upper cost-effectiveness threshold limit.