Rationality and cost-effectiveness of diagnosis and treatment of group A streptococci in primary care patients with pharyngitis.
Rationality and cost-effectiveness of several strategies for diagnosing and treating sore throat patients were evaluated in primary care. In an empirical material of 2016 patients, 3 different bacteriological methods (traditional culture, slide culture, and latex agglutination test) for the detection of group A beta-hemolytic streptococci (GAS) were compared. Sensitivity analyses were done for several variables, including GAS test performance, testing frequencies, medication rates, and accuracy of clinical evaluation. The amounts of unnecessary medication varied from 19 to 33%, and there were 2.2-8.9% of untreated GAS infections. Strategies based on bacteriology achieved more rational and economic results than treating no one, treating all patients, or using clinical evaluation without bacteriology. The cost-effectiveness of the latex agglutination test depended on the sensitivity of the test. The results were further sensitive to sick leave lengths, cost of antibacterials, and clinical accuracy, but not to GAS test cost. Rapid tests for GAS detection can be recommended, if the sensitivity of the test in the actual working conditions is acceptable.
Mäkelä
M
M
Department of General Practice and Primary Care, University of Helsinki, Finland.
Sintonen
H
H
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007841:Latex Fixation Tests / Q000191:economics; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*