Interim evaluation of sore throat management services within the RFPP Ministry of Health response
Limitations that we ll need to address before the final evaluation Improving data quality and completeness Collecting NHI of service users (whether swabbed or not) Labelling of throat swabs to enable determination of service they came from Clarifying costs of services Agreeing the appropriate comparator for cost effectiveness studies
Key findings Rheumatic fever incidence is decreasing The decrease is statistically significant The decrease is associated in time and place with aspects of programme implementation Full implementation of the school based services Implementation of rapid response services in South Auckland Introduction of rapid response and healthy homes services in other areas
Key findings in relation to the school based services Non statistically significant reductions in RF incidence of 17% nationally and 31% in South Auckland Consistent with the RCT Lennon et al 2009 Underpowered to demonstrate statistical significance if effectiveness below 50% Could be as effective as 42% or ineffective as 0% but likely to be around the middle Reduction in RF incidence also occurred in 5-12 year olds who did not attend a school-based programme
Key findings in relation to the school based services (2) The school based services may be an important component of a DHB s ability to achieve their target in some areas Given the effectiveness range and population reach achieved, the school based services alone won t achieve the target of 67% reduction. The school based service has a relatively high cost per QALY compared to a number of other preventive interventions but We need to agree a more meaningful comparator
What does this mean for DHBs? Need to properly consider additional ways to ensure rapid and effective access to sore throat management for their priority populations. Need to assess whether having school based services in their area is the best use of resource to ensure access to effective sore throat management in their priority populations. Will need to take into account Ability to reach high proportion of the priority populations Cost per child per annum Level of effectiveness demonstrated so far in their communities Those who choose to continue to invest in school based services need to explore ways to make them more cost effective - reduce costs and/or increase benefits and co-benefits.
Other implications of the evaluation Confirms the need for interventions to prevent cases which don t have a preceding sore throat. Unclear whether the work to reduce the strep load within the community through throat swabbing of asymptomatic people is effective probably not and will lead to unnecessary antibiotic use. Ministry recommends a focus on ensuring the healthy homes initiatives are working well in your area.
Expectations of the Ministry for DHBs following this interim evaluation Ensure a balanced portfolio of interventions in your area to reduce rheumatic fever incidence including Community awareness raising and active promotion of community based services Sore throat management services that are able to be easily accessed by 80% of your priority population Sore throat management services that rapidly and effectively treat all high risk clients Sore throat management services that actively promote antibiotic adherence Healthy homes initiatives that are supported and implemented well
Expectations of the Ministry following this interim evaluation Make your investment decisions clear in your refreshed rheumatic fever prevention plans Justify your decisions based on The findings of this interim evaluation The views of stakeholders and priority communities Other relevant evidence Commit to supporting the collection of the data required to ensure an appropriate final evaluation Ensure flexibility to change decisions based on new evidence