title: Diagnosis and management of acute pharyngitis in a paediatric population: a cost-effectiveness analysis.
abstract: 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 <euro>. 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.
authors.affiliation: Service of Preventive Medicine, "La Paz" University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain. cvalle.giraldez@salud.madrid.org
authors.forename: Carolina
authors.initials: C
authors.lastname: Giraldez-Garcia
authors.forename: Beltran
authors.initials: B
authors.lastname: Rubio
authors.forename: Jose F
authors.initials: JF
authors.lastname: Gallegos-Braun
authors.forename: Iñaki
authors.initials: I
authors.lastname: Imaz
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez-Enriquez
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarria-Santamera
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000942:Antigens, Bacterial / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003948:Diagnostic Techniques, Respiratory System / Q000191:economics*; D006801:Humans; D010612:Pharyngitis / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology / Q000628:therapy; D012680:Sensitivity and Specificity; D013030:Spain; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000191:economics; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000942:Antigens, Bacterial