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.

Impacto do uso de técnicas microbiológicas para o estreptococo beta hemolítico do grupo A no diagnóstico e tratamento das faringotonsilites

“…Dentre as infecções de vias aéreas superiores, é queixa freqüente na faixa etária pediátrica (Ayanruoh et al, 2009;Giraldez-Garcia et al, 2011;Le Marechal et al, 2013) . Em todo o mundo, é responsável por cerca de 5 a 20% dos atendimentos em serviços de emergência pediátrica (Pichichero, 1995;Atlas et al, 2005;Ayanruoh et al, 2009;Giraldez-Garcia et al, 2011;Regoli et al, 2011) .…”

“…Em todo o mundo, é responsável por cerca de 5 a 20% dos atendimentos em serviços de emergência pediátrica (Pichichero, 1995;Atlas et al, 2005;Ayanruoh et al, 2009;Giraldez-Garcia et al, 2011;Regoli et al, 2011) .…”

“…Entretanto, os escores descritos apresentam variação de sensibilidade de 12 a 93% e especificidade de 30 a 93% (Breese, 1977;Steinhoff et al, 1997;McIsaac et al, 1998;Wald et al, 1998;Bisno et al, 2002;Ebell, 2003;Rimoin et al, 2005;Santos et al, 2005;Smeesters et al, 2006) (Figura 1). (Buchbinder et al, 2007;Morais et al, 2009;Chiappini et al, 2011;Giraldez-Garcia et al, 2011;Piñeiro-Pérez et al, 2011;Regoli et al, 2011) forma, a conduzir seu uso de maneira mais prudente, evitando, assim, o surgimento e a propagação de cepas de bactérias resistentes aos antibióticos, assim como evitar os eventos adversos causados pelo uso do antibiótico Regoli et al, 2011;Weber, 2014).…”

“…Dentre os métodos microbiológicos disponíveis, a cultura de orofaringe semeada em ágar sangue é o padrão-ouro para o diagnóstico da faringotonsilite estreptocócica do grupo A (Pichichero, 1995;Needham et al, 1998;Schwartz et al, 1998;Webb, 1998;American Academy of Pediatrics, 2000;Bisno et al, 2002;Giesseker et al, 2002;Santos et al, 2005;Wald, 2007;Ayanruoh et al, 2009;Cardoso et al, 2009;Gerber et al, 2009;Morais et al, 2009;Tanz et al, 2009;Giraldez-Garcia et al, 2011;Piñeiro-Pérez et al, 2011;Regoli et al, 2011;Shulman et al, 2012;Cardoso et al, 2013). Vários fatores podem interferir na eficácia diagnóstica da cultura de orofaringe, como a técnica de coleta, a capacidade técnica do indivíduo que realiza o exame, assim como a capacidade técnica do laboratório em que é realizada.…”

“…Esses resultados corroboram os dados de literatura que apontam a faringotonsilite, dentre as IVAS, como causa frequente de consultas. Estima-se que, no mundo todo, os atendimentos pediátricos relacionados às faringotonsilites variem de 1,3% a 20% (Atlas et al, 2005;Ayanruoh et al, 2009;Choby, 2009;Chiappini et al, 2011;Giraldez-Garcia et al, 2011;Regoli et al, 2011;Wessels, 2011;Shulman et al, 2012). Dados norte-americanos mostram que 11 a 15 milhões de atendimentos/ano são realizados em função de dor de garganta (Choby, 2009;Shulman et al, 2012).…”