Background: Early rheumatic heart disease (RHD) diagnosis relies on screening at-risk populations followed by confirmatory echocardiography for screen-positive cases. In Uganda, screening is conducted in schools, but confirmation typically requires travel to regional hospitals (Strategy A), incurring costs to families. Confirmatory echocardiography can alternatively be performed at schools (Strategy B). This study estimates the costs for screening both confirmatory strategies, using data collected alongside the GOALIE trial.1
Methods: We used an ingredients-based approach to estimate the costs per child for screening and confirmatory echocardiography from both healthcare system and societal perspectives. Data sources included the Uganda National RHD Registry, medical stores, UNICEF catalogues, and interviews with Uganda Heart Institute staff and families enrolled in the GOALIE trial. Costs are presented in 2023 US dollars.
Results: The health system cost for screening echocardiography was $1.25, with a minor productivity loss of $0.05 per student. For confirmatory echocardiography, the health system cost was $20.78 for Strategy A and $19.70 for Strategy B, while societal costs were $9.46 and $0 respectively. The highest cost drivers for both confirmatory strategies were the portable echocardiography machine and the RHD expert’s salary (over $5 each), along with travel and per diem costs for RHD experts providing confirmatory expertise in districts.
Conclusion: Screening echocardiography is inexpensive, and health system perspective costs of confirmatory echocardiography are similar in hospitals and schools. However, hospital-based confirmation imposes significant costs on families. School-based confirmation could reduce these burdens, and having resident cardiologists in regional hospitals could further lower expenses.