Management of sore throats in children: A cost-effectiveness analysis

Joel Tsevat, Uma R. Kotagal

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)681-688
Number of pages8
JournalArchives of Pediatrics and Adolescent Medicine
Volume153
Issue number7
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

Fingerprint

Pharyngitis
Cost-Benefit Analysis
Pharynx
Costs and Cost Analysis
Streptococcus
Immunoenzyme Techniques
Immunoassay
Penicillin V
Hospital Laboratories
Rheumatic Fever
Amoxicillin
Therapeutics
Penicillins
Signs and Symptoms
Anti-Bacterial Agents
Antigens

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Management of sore throats in children : A cost-effectiveness analysis. / Tsevat, Joel; Kotagal, Uma R.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 153, No. 7, 01.01.1999, p. 681-688.

Research output: Contribution to journalArticle

@article{20ef6142c1e2496babe132a38859c697,
title = "Management of sore throats in children: A cost-effectiveness analysis",
abstract = "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.",
author = "Joel Tsevat and Kotagal, {Uma R.}",
year = "1999",
month = "1",
day = "1",
doi = "10.1001/archpedi.153.7.681",
language = "English (US)",
volume = "153",
pages = "681--688",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Management of sore throats in children

T2 - A cost-effectiveness analysis

AU - Tsevat, Joel

AU - Kotagal, Uma R.

PY - 1999/1/1

Y1 - 1999/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0032975392&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032975392&partnerID=8YFLogxK

U2 - 10.1001/archpedi.153.7.681

DO - 10.1001/archpedi.153.7.681

M3 - Article

C2 - 10401800

AN - SCOPUS:0032975392

VL - 153

SP - 681

EP - 688

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 7

ER -