ANALYSIS OF COSTS OF ACUTE RHEUMATIC-FEVER AND RHEUMATIC HEART-DISEASE IN AUCKLAND

Aim. This analysis aims to identify the direct costs of rheumatic feve r and its sequelae to the Auckland Area Health Board and to describe t he indirect and intangible costs to patients. Methods. The annual cost was estimated using primarily 1987 data costed in 1991 dollars. The c ost analysis was undertaken in five sections: (1) acute rheumatic feve r admissions; (2) surgical admissions; (3) rheumatic heart disease rel ated admissions (nonsurgical); (4) outpatient clinic appointments; and (5) secondary prophylaxis programme. Non hospital board direct costs and indirect and intangible costs are described. Ethnic distribution a nd subsequent economic burden were analysed for each section. Results. The total cost to the health board was estimated to be $3.60M. The ma nagement of chronic rheumatic heart disease accounts for 71% of the co st. Rheumatic heart disease related nonsurgical admissions cost $1 228 495 (34%), surgical admissions $846235 (23%) and outpatient clinic ap pointments $490060 (14%) respectively. Both Maori (30% of costs, $1.1M ) and Pacific Island people (36% of costs, $1.3M) are disproportionate ly affected by this largely preventable disease. Of the total cost 13% is spent on coordinated secondary prevention programmes. Conclusion. An energetic secondary prevention programme over 10 years to prevent r ecurrences and the development of carditis has only partially reduced the rate of rheumatic heart disease. A targeted primary prevention pil ot programme should be actively considered.