North D A, Heynes R A, Lennon D R, Neutze J
Department of General Practice, Green Lane Hospital, Auckland.
N Z Med J. 1993 Sep 22;106(964):400-3.
This analysis aims to identify the direct costs of rheumatic fever and its sequelae to the Auckland Area Health Board and to describe the indirect and intangible costs to patients.
The annual cost was estimated using primarily 1987 data costed in 1991 dollars. The cost analysis was undertaken in five sections: (1) acute rheumatic fever admissions; (2) surgical admissions; (3) rheumatic heart disease related 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 and subsequent economic burden were analysed for each section.
The total cost to the health board was estimated to be $3.60M. The management of chronic rheumatic heart disease accounts for 71% of the cost. Rheumatic heart disease related nonsurgical admissions cost $1,228,495 (34%), surgical admissions $846,235 (23%) and outpatient clinic appointments $490,060 (14%) respectively. Both Maori (30% of costs, $1.1M) and Pacific Island people (36% of costs, $1.3M) are disproportionately affected by this largely preventable disease. Of the total cost 13% is spent on coordinated secondary prevention programmes.
An energetic secondary prevention programme over 10 years to prevent recurrences and the development of carditis has only partially reduced the rate of rheumatic heart disease. A targeted primary prevention pilot programme should be actively considered.
本分析旨在确定风湿热及其后遗症给奥克兰地区卫生局带来的直接成本，并描述患者的间接成本和无形 成本。
主要使用按1991年美元计算的1987年数据估算年度成本。成本分析分五个部分进行：（1）急性风湿热住院治疗；（2）外科手术住院治疗；（3）风湿性心脏病相关住院治疗（非手术）；（4）门诊预约；以及（5）二级预防计划。描述了非卫生局直接成本以及间接成本和无形 成本。对每个部分的种族分布及后续经济负担进行了分析。
卫生局的总成本估计为360万美元。慢性风湿性心脏病的管理占成本的71%。风湿性心脏病相关的非手术住院治疗费用为1,228,495美元（34%），外科手术住院治疗费用为846,235美元（23%），门诊预约费用为490,060美元（14%）。毛利人（占成本的30%，110万美元）和太平洋岛民（占成本的36%，130万美元）受这种在很大程度上可预防疾病的影响尤为严重。总成本的13%用于协调二级预防计划。
一项为期10年的积极二级预防计划，以预防复发和心肌炎的发生，仅部分降低了风湿性心脏病的发病率。应积极考虑开展有针对性的一级预防试点计划。
