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

Objective: To perform a cost-effectiveness analysis of treatment management strategies for children older than 3 years who present with signs or sympt oms of pharyngitis. Design: Decision model with 7 strategies, including neither testing for str eptococcus nor treating with antibiotics; treating empirically with penicil lin V; basing treatment on results of a throat culture (Culture); and basin g treatment on results of enzyme immunoassay or optical immunoassay rapid t ests, performed alone or in combination with throat cultures. In these 7 st rategies, all tests are performed in a local reference laboratory. In a sen sitivity analysis, we examined the cost-effectiveness of 4 strategies invol ving 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, t he Culture strategy was the least expensive and most effective, with an ave rage 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 cultu re results. The Culture strategy was also preferred if amoxicillin was subs tituted for oral penicillin. For office-based testing, Culture was the leas t costly strategy, but treatment based on results of the optical immunoassa y test alone had an incremental cost-effectiveness ratio of $1.6 million pe r additional life saved. Conclusion: In a setting with adherent patients, children with sore throats should generally get throat cultures in lieu of rapid streptococcus antige n tests.