Resource utilization and cost of rheumatic fever

Objective. The socioeconomic effects of rheumatic fever (RF) in Brazil, inc luding direct and indirect costs to patients and their families and to soci ety, are largely unknown. We evaluated the utilization of resources and cos ts related to RF in a tertiary center caring for low income patients in the city of Sao Paulo, Brazil. Methods. One hundred patients with RE younger than 18 yrs, with followup of at least one year, were sequentially selected to provide complete informat ion on a questionnaire. Additional data were collected from patients' chart s. The utilization of resources was evaluated for each patient throughout t he entire disease course. Costs were determined for patients and their fami lies as well as for the society, using variables from 3 different systems: the national public health system, used by most lower income groups; the Br azilian Medical Association, which regulates charges and fees utilized by h ealth plans and insurance companies; and costs charged by private practitio ners, paid directly by patients. Results, The RF population studied belonged to a low socioeconomic level. T he mean monthly family income was $625.20 US. The mean disease duration was 3.9 yrs (range 1-10). Patients had a total of 1657 medical consultations, 22 hospital admissions, and 4 admissions to intensive care unit. Work absen teeism among parents was calculated as 22.9%, equivalent to 901 days of mis sed work; about 5% of the parents lost their jobs. Patients showed a high r ate of school failure (22%). Considering the public system as a reference, direct, indirect, and total costs to society per 100 patients throughout th e entire disease duration were $105,860 US ($271/patient/yr), $18,803 US ($ 48/patient/yr), and $124,663 US (US $319/patient/yr), respectively. When he alth care plan and private systems were taken as reference, the total costs were $423,550 US and $684,351 US, respectively. Conclusion. RF and rheumatic heart disease have an important socioeconomic impact in Brazil; costs of RF made up roughly 1.3% of annual family income. The estimated annual cost of RF for society in Brazil is $51,144,347.00 US .