Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared to traditional intramuscular injections

William Leung; Michael G Baker; Laurens Manning; Julie Bennett

doi:10.1016/j.ijregi.2025.100784

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Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared to traditional intramuscular injections

Journal article

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Peer reviewed

Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared to traditional intramuscular injections

William Leung, Michael G Baker, Laurens Manning and Julie Bennett

IJID regions, Vol.17, 100784

06/10/2025

DOI: https://doi.org/10.1016/j.ijregi.2025.100784

Handle:

https://hdl.handle.net/10523/48382

Abstract

Penicillin

Intramuscular

Subcutaneous

Rheumatic fever

Cost-saving

Objectives: Acute rheumatic fever (ARF) is a preventable condition that can lead to chronic illness and early death. Standard prevention with four-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 versus IM BPG injections in NZ children with a first-ARF presentation and no/mild carditis. Methods: Treatment administration costs and productivity losses from SCIP versus IM BPG were modelled 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$1,629 for a 10-year-old. Over a full course, SCIP consistently offered societal cost-savings, especially in younger children and higher-adherence scenarios. Conclusion: 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

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Record Identifier: 9926780689801891
Title: Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared to traditional intramuscular injections
Creators: William Leung
Michael G Baker
Laurens Manning
Julie Bennett
Publication Details: IJID regions, Vol.17, 100784
Academic Unit: Public Health (UOW)
Publisher: Elsevier
Grant note: Te Niwha Infectious Disease Research Platform, New Zealand
Date published ; e-published: 06/10/2025
Copyright: Copyright © The Author(s) 2025. This work was first published in IJID Regions (Elsevier). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://www.creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, provided that the original work is properly attributed to the creator(s) and the source, a link to the Creative Commons license is provided, and any changes made are indicated.
Language: English
Resource Type ; Subtype: Journal article