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Management of Sore Throats in Children
A Cost-effectiveness Analysis
Joel Tsevat, MD, MPH;
Uma R. Kotagal, MD, MSc
Arch Pediatr Adolesc Med. 1999;153:681-688.
Objective To perform a cost-effectiveness analysis of treatment management strategies for children older than 3 years who present with signs or symptoms of pharyngitis.
Design Decision model with 7 strategies, including neither testing for streptococcus nor treating with antibiotics; treating empirically with penicillin V; basing treatment on results of a throat culture (Culture); and basing treatment on results of enzyme immunoassay or optical immunoassay rapid tests, performed alone or in combination with throat cultures. In these 7 strategies, all tests are performed in a local reference laboratory. In a sensitivity analysis, we examined the cost-effectiveness of 4 strategies involving office-based testing. We obtained data on event probabilities and test characteristics from our hospital's clinical laboratory and the literature; costs for the analysis were based on resource use.
Results At a baseline prevalence of 20.8% for streptococcal pharyngitis, the Culture strategy was the least expensive and most effective, with an average cost of $6.85 per patient. The outcome was sensitive to the prevalence of streptococcal pharyngitis, the rheumatic fever attack rate, the cost of the enzyme immunoassay test, and the cost of culturing and reporting culture results. The Culture strategy was also preferred if amoxicillin was substituted for oral penicillin. For office-based testing, Culture was the least costly strategy, but treatment based on results of the optical immunoassay test alone had an incremental cost-effectiveness ratio of $1.6 million per additional life saved.
Conclusion In a setting with adherent patients, children with sore throats should generally get throat cultures in lieu of rapid streptococcus antigen tests.
From the Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine (Dr Tsevat), Divisions of Neonatology and Health Policy and Clinical Effectiveness, Department of Pediatrics (Dr Kotagal), and Institute for Health Policy and Health Services Research (Drs Tsevat and Kotagal), University of Cincinnati Medical Center and Children's Hospital Medical Center, Cincinnati, Ohio.
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