ABC | Volume 113, Nº3, September 2019

Original Article Figueiredo et al. Rheumatic fever: a disease without color Arq Bras Cardiol. 2019; 113(3):345-354 Figure 3 – Growth trends (A) and predicted values (B) for total costs with RHD. The model equation for the total costs with RHD (C) was RDH TC = –8346,31 + 4,19 * Year. It should be noted that all trends were significant (p-value < 0.050), evidencing the increasing trend of the series over time. 1998 100 80 60 40 20 2000 2002 2004 2006 Time 2008 2010 2012 2014 2016 1998 2000 2002 2004 2006 Time 2008 2010 2012 2014 2016 2018 2020 RHD total costs over time (A) Predicted values for RHD total costs (B) Cost in millions of reais 100 80 60 40 20 Cost in millions of reais Time series Time series Adjusted Values Predicted values Trend Figure 4 – Projection of estimated minimum annual costs in US dollars for Rheumatic Heart Disease morbidities. The final values were calculated based on the case estimates made in Figure 2, multiplying by the values detailed in Table 1, taking into account only one procedure or one hospitalization for each patient over time. Infective Endocartitis; $224,421.12 Heart Failure; $148,946.53 Atrial Fibrillation; $305,287.31 Ischemic Stroke; $740,360.47 Cardiac Surgery; $14,562,519.12 Total Costs: US$15,981,534.55 The proposal of the World Health Organization (WHO), to reducemortality fromRHDandotherNCDs (noncommunicable diseases) by 25% by the year 2025, requires an understanding of the contemporary characteristics and the use of proven interventions in patients living in endemic countries. 19 Taking into account our projections, this WHO proposal is far from our reality, which could be associated to the fact that ARF and RHD are diseases of poverty. Moreover, although ARF and RHD have largely disappeared from affluent parts of the world, they remain an important cause of morbidity and mortality in low-income countries and among marginalized sections of society in high-income countries. 20 These conditions had an impact on the costs of the National Health System, with a remarkable 264% increase in total expenditures with hospitalization for RHD from 1998 to 2016. Considering the current scenario, our predicted values point out the increment of 5.4% for the period from 2017 to 2018 and 1.5% from 2018 to 2019. TheWHOdefines secondary prophylaxis as “the continuous administration of specific antibiotics to patients with a previous attack of rheumatic fever, or well-documented rheumatic heart disease. The purpose is to prevent colonization or infection of the upper respiratory tract with GAS and the development of recurrent attacks of rheumatic fever”. 4 The internationally accepted dose for secondary prophylaxis with BPG in adults is 900 mg (1.2 million IU) intramuscularly. There is some uncertainty regarding the optimal frequency of administration; some studies suggest 2-weekly administration, whereas others report very good outcomes with a 3-weekly regimen 21 as established by the last Brazilian guideline. 1 Meanwhile, the value standardized by ANVISA's Drug Market Regulation Chamber for Benzathine Penicillin G is R$ 14.75 or US$ 4.48. 15 Considering the number of cases due to the evolution of ARF into RHD with its complications (Figure 2) multiplied by the respective costs of procedures (Table 1) we reached the hypothetical value spent in 1 year 349