Diagnosis and management of acute pharyngitis in a paediatric population: a cost–effectiveness analysis

• Published in: European journal of pediatrics Vol. 170; no. 8; pp. 1059 - 1067
• Main Authors: Giraldez-Garcia, Carolina, Rubio, Beltran, Gallegos-Braun, Jose F, Imaz, Iñaki, Gonzalez-Enriquez, Jesus, Sarria-Santamera, Antonio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2011; Springer; Springer Nature B.V
• Subjects: Acute Disease; Adolescent; Antibiotics; Antigens; Antigens, Bacterial - analysis; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Cost analysis; Cost-Benefit Analysis; Decision Support Techniques; Decision Trees; Diagnostic Techniques, Respiratory System - economics; Drug resistance; General aspects; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Medicine; Medicine & Public Health; Original Paper; Pediatrics; Penicillin; Pharyngitis - diagnosis; Pharyngitis - economics; Pharyngitis - microbiology; Pharyngitis - therapy; Preventive medicine; Primary care; Sensitivity analysis; Sensitivity and Specificity; Spain; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcal Infections - diagnosis; Streptococcal Infections - economics; Streptococcus pyogenes - immunology; Streptococcus pyogenes - isolation & purification; Spain; Group A streptococcus; Acute pharyngitis; Rapid diagnostic tests; Streptococcal pharyngitis; Costs and cost analysis; Pediatrics; Angina; Streptococcus β hémolytique; Rapid technique; Streptococcal infection; Bacteria; Micrococcales; ENT disease; Population; Pharynx disease; Diagnosis; Child; Cost efficiency analysis; Human; Acute; Management; Infection; Streptococcaceae; Clinical management; Treatment; Health economy; Bacteriosis; Pharyngitis; Cost analysis
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-011-1410-0

Acute pharyngitis is one of the most frequent causes of primary care physician visits; however, there is no agreement about which is the best strategy to diagnose and manage acute pharyngitis in children. The aim of the current study was to evaluate the cost–effectiveness of the recommended strategies to diagnose and manage acute pharyngitis in a paediatric population. A decision tree analysis was performed to compare the following six strategies: “treat all”, “clinical scoring”, “rapid test”, “culture”, “rapid test + culture” and “clinical scoring + rapid test”. The cost data came from the Spanish National Health Service sources. Cost–effectiveness was calculated from the payer’s perspective. Effectiveness was measured as the proportion of patients cured without complications from the disease and did not have any reaction to penicillin therapy; a sensitivity analysis was performed. The findings revealed that the “clinical scoring + rapid test” strategy is the most cost-effective, with a cost–effectiveness ratio of 50.72 €. This strategy dominated all others except “culture”, which was the most effective but also the most costly. The sensitivity analysis showed that “rapid test” became the most cost-effective strategy when the clinical scoring sensitivity was <91% and its specificity was ≤9%. In conclusion, the use of a clinical scoring system to triage the diagnoses and performing a rapid antigen test for those with a high score is the most cost-effective strategy for the diagnosis and management of acute pharyngitis in children. When the clinical scoring system has a low diagnostic accuracy, testing all patients with rapid test becomes the most cost-effective strategy.