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Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared with traditional intramuscular injections
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DOI：10.1016/j.ijregi.2025.100784.png)
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Abstract
En 中文
Objectives: Acute rheumatic fever is a preventable condition that can lead to chronic illness and early death. Standard prevention with 4-weekly intramuscular (IM) benzathine penicillin G (BPG) injections for >= 10 years may be associated with poor adherence. High-dose 10-weekly subcutaneous penicillin injections (SCIP) may improve adherence by reducing injection frequency. Since 2025, SCIP has been included in the repository of standard operating procedures in lower North Island hospitals in New Zealand (NZ). We compare the costs of delivering a full course of secondary prophylaxis using SCIP vs IM BPG injections in NZ children with a first acute rheumatic fever presentation and no/mild carditis. Methods: Treatment administration costs and productivity losses from SCIP vs IM BPG were modeled using real-world survey data on time off school and work. Starting age of secondary prophylaxis, adherence, and administration site over the treatment period were varied. Costs are in 2024 NZ$, discounted at 3.5%. Results: SCIP reduced 12-month costs by nearly half to NZ$ 1629 for a 10-year-old child. Over a full course, SCIP consistently offered societal cost-savings, especially in younger children and higher adherence scenarios. Conclusions: Prevention using SCIP is cost-saving to NZ society. Increased adherence to SCIP may contribute to longer, healthier lives for those diagnosed with rheumatic fever.
Keywords:
Penicillin
Intramuscular
Subcutaneous
Rheumatic fever
Cost-saving
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