title: [Diagnostic strategies for acute tonsillitis in France: a cost-effectiveness study].
abstract: BACKGROUND
  Inability to identify clinically group A streptococcal (GAS) tonsillitis has resulted for a long time in treating all tonsillitis with antibiotics in France. The use of the rapid detection tests (RDT) for GAS is currently recommended, in order to keep antibiotics only for GAS tonsillitis. Our objective was to carry out a cost-effectiveness analysis, comparing various strategies for the management of acute tonsillitis in France.
  
  
  METHODS
  We used a decision analysis model, including seven strategies (S) for tonsillitis management, specifically in children and in adults: S1: observation only (reference strategy); S2: clinical scoring; S3: RDT testing; S4: throat culture; S5: clinical scoring combined with RDT testing; S6: RDT testing combined with throat culture; S7: systematic antibiotic therapy. The criterion for effectiveness was the absence of locoregional suppurative complications.
  
  
  RESULTS
  The use of the RDT alone had the best cost-effectiveness ratio in both adults and children. For this strategy, we estimated the cost per suppurative complication avoided at 970€ in children and at 903€ in adults. For the strategy associating a confirmative throat culture to the RDT, the extra cost per suppurative complication avoided was estimated at 106,666€ in children and at 228,000€ in adults. Sensitivity analysis showed the stability of the model while making the main parameters vary.
  
  
  CONCLUSIONS
  In acute tonsillitis, in both adults and children, RDT testing by practitioners is the more efficient strategy to identify and treat patients with GAS tonsillitis. Combining RDT testing with throat culture can provide additional effectiveness, but at the cost of a significant extra charge for the community.
authors.affiliation: Hospices civils de Lyon, pôle d'information médicale, évaluation et recherche, 69424 Lyon cedex 03, France.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Maizia
authors.forename: Laurent
authors.initials: L
authors.lastname: Letrilliart
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
mesh_terms: D000328:Adult; D000075202:Contraindications; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008508:Medication Errors; D059065:Medication Reconciliation; D010351:Patient Discharge; D055553:Prescription Drugs; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs