Antibiotic Prophylaxys/economics

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Editorial

Rheumatic Fever in Brazil: What Color Should It Be?

Rheumatic fever (RF) and its valvular sequela rheumatic heart disease (RHD) have been a scourge on humanity for ages, and it is only relatively recently that high-income countries have seen rates of RF decline dramatically. Yet, the Global Burden of Disease Study estimates that more than 275,000 deaths due to RHD still occur every year around the world, especially in low and middle-income countries including Brazil.

In this issue of the journal, Figueiredo et al. have presented ambitious modeling of the disease burden and costs of RF and RHD in Brazil. Using data from the Hospital Information System of Brazil, their central findings are that mortality rates for RF and RHD have increased by 215% and 42.5% respectively from 1998 to 2016. Additionally, the estimated cost for procedures related to RF/RHD diagnosis, interventions such as valve surgery, and hospitalizations for RHD complications like stroke and endocarditis was nearly $27 million USD in 2019.

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Original Article

Rheumatic Fever: A Disease without Color

Estevão Tavares de Figueiredo et al. Luciana Azevedo Marcelo Lacerda Rezende Cristina Garcia Alves

Abstract

Background:

Brazil has approximately 30.000 cases of Acute Rheumatic Fever (ARF) annually. A third of cardiovascular surgeries performed in the country are due to the sequelae of rheumatic heart disease (RHD), which is an important public health problem.

Objectives:

to analyze the historical series of mortality rates and disease costs, projecting future trends to offer new data that may justify the need to implement a public health program for RF.

Methods:

we performed a cross-sectional study with a time series analysis based on data from the Hospital Information System of Brazil from 1998 to 2016. Simple linear regression models and Holt’s Exponential Smoothing Method were used to model the behavior of the series and to do forecasts. The results of the tests with a value of p < 0.05 were considered statistically significant.

Results:

each year, the number of deaths due to RHD increased by an average of 16.94 units and the mortality rate from ARF increased by 215%. There was a 264% increase in hospitalization expenses for RHD and RHD mortality rates increased 42.5% (p-value < 0.05). The estimated mortality rates for ARF and RHD were, respectively, 2.68 and 8.53 for 2019. The estimated cost for RHD in 2019 was US$ 26.715.897,70.

Conclusions:

according to the Brazilian reality, the 1-year RHD expenses would be sufficient for secondary prophylaxis (considering a Benzatin Penicillin G dose every 3 weeks) in 22.574 people for 10 years. This study corroborates the need for public health policies aimed at RHD.