Related Experiment Videos
Management of sore throats in children: a cost-effectiveness analysis
1Department of Internal Medicine, University of Cincinnati Medical Center, Ohio 45267-0535, USA. joel.tsevat@uc.edu
Insights
For children over 3 with sore throats, throat cultures are more cost-effective than rapid strep tests. This strategy is the least expensive and most effective for managing streptococcal pharyngitis.
Area of Science:
- Pediatric Infectious Diseases
- Health Economics
- Clinical Microbiology
Background:
- Pharyngitis is a common childhood illness, often caused by Streptococcus pyogenes.
- Accurate diagnosis is crucial to prevent complications like rheumatic fever and to avoid unnecessary antibiotic use.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of different management strategies for pediatric pharyngitis.
- To compare testing and treatment approaches for children over 3 years old presenting with pharyngitis symptoms.
Main Methods:
- A decision model evaluated seven management strategies, including empirical treatment, throat culture, and rapid antigen detection tests (RADTs).
- Cost-effectiveness was analyzed for both laboratory-based and office-based testing scenarios.
- Data on probabilities, test characteristics, and costs were derived from clinical data and literature.
Main Results:
- The throat culture strategy was the most cost-effective and effective at a baseline prevalence of 20.8% for streptococcal pharyngitis.
- Sensitivity analyses showed the results were influenced by prevalence, rheumatic fever rates, and test/culture costs.
- Office-based throat cultures were the least costly strategy, while optical immunoassay alone was significantly more expensive per life saved.
Conclusions:
- Throat cultures are recommended over rapid streptococcus antigen tests for diagnosing pharyngitis in children over 3.
- This approach is particularly effective in settings with good patient adherence to testing protocols.
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.