Tsevat J, Kotagal U R
Department of Internal Medicine, University of Cincinnati Medical Center, Ohio 45267-0535, USA.
Arch Pediatr Adolesc Med. 1999 Jul;153(7):681-8. doi: 10.1001/archpedi.153.7.681.
To perform a cost-effectiveness analysis of treatment management strategies for children older than 3 years who present with signs or symptoms of pharyngitis.
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.
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.
In a setting with adherent patients, children with sore throats should generally get throat cultures in lieu of rapid streptococcus antigen tests.
对出现咽炎体征或症状的3岁以上儿童的治疗管理策略进行成本效益分析。
具有7种策略的决策模型，包括既不进行链球菌检测也不使用抗生素治疗；经验性使用青霉素V治疗；根据咽拭子培养结果进行治疗（培养法）；根据酶免疫测定或光学免疫测定快速检测结果进行治疗，单独进行或与咽拭子培养联合进行。在这7种策略中，所有检测均在当地参考实验室进行。在敏感性分析中，我们研究了4种基于门诊检测的策略的成本效益。我们从我院临床实验室和文献中获取了事件概率和检测特征的数据；分析成本基于资源使用情况。
在链球菌性咽炎基线患病率为20.8%时，培养法策略是最便宜且最有效的，每位患者平均成本为6.85美元。结果对链球菌性咽炎患病率、风湿热发作率、酶免疫测定检测成本以及培养和报告培养结果的成本敏感。如果用阿莫西林替代口服青霉素，培养法策略也是首选。对于基于门诊的检测，培养法是成本最低的策略，但仅基于光学免疫测定检测结果的治疗每多挽救一条生命的增量成本效益比为160万美元。
在患者依从性良好的情况下，咽痛儿童一般应进行咽拭子培养，而不是快速链球菌抗原检测。
