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- Title
Diagnosis and Management of Adults with Pharyngitis.
- Authors
Neuner, Joan M.; Hamel, Mary Beth; Phillips, Russell S.; Bona, Kira; Aronson, Mark D.
- Abstract
Background: Rheumatic fever has become uncommon in the United States while rapid diagnostic test technology for streptococcal antigens has improved. However, little is known about the effectiveness or cost-effectiveness of various strategies for managing pharyngitis caused by group A 3-hemolytic streptococcus (GAS) in U.S. adults. Objective: To examine the cost-effectiveness of several diagnostic and management strategies for patients with suspected GAS pharyngitis. Design: Cost-effectiveness analysis. Data Sources: Published literature, including systematic reviews where possible. When costs were not available in the literature, we estimated them from our institution and Medicare charges. Target Population: Adults in the general U.S. population. Time Horizon: 1 year. Perspective: Societal. Interventions: Five strategies for the management of adult patients with pharyngitis: 1) observation without testing or treatment, 2) empirical treatment with penicillin, 3) throat culture using a two-plate selective culture technique, 4) optical immunoassay (OIA) followed by culture to confirm negative OIA test results, or 5) OIA alone. Outcome Measures: Cost per lost quality-adjusted life-days (converted to life-years where appropriate) and incremental cost-effectiveness. Results of Base-Case Analysis: Empirical treatment was the least effective strategy at a GAS pharyngitis prevalence of 10% (resulting in 0.41 lost quality-adjusted life-day). Although the other four strategies had similar effectiveness (all resulted in about 0.27 lost quality-adjusted life-day), culture was the least expensive strategy. Results of Sensitivity Analyses: Results were sensitive to the prevalence of GAS pharyngitis: OIA followed by culture was most effective when GAS pharyngitis prevalence was greater than 20%. Observation was least expensive when prevalence was less than 6%, and empirical treatment was least expensive when prevalence was greater than 71%. The effectiveness of strategies was...
- Subjects
UNITED States; RHEUMATIC fever; PHARYNGITIS; MEDICAL care costs
- Publication
Annals of Internal Medicine, 2003, Vol 139, Issue 2, p113
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-139-2-200307150-00011