[Diagnostic strategies for acute tonsillitis in France: a cost-effectiveness study].
[Diagnostic strategies for acute tonsillitis in France: a cost-effectiveness study].
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DOI：
10.1016/j.lpm.2011.10.021
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发表时间：
2012-04-01
期刊：
影响因子：
--
通讯作者：
Colin, Cyrille
中科院分区：
文献类型：
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作者：
Maizia, Abdelkader;Letrilliart, Laurent;Colin, Cyrille
背景：在法国，长期以来使用抗生素治疗所有扁桃体炎时都无法在临床上识别 A 组链球菌 (GAS) 扁桃体炎。目前建议使用 GAS 快速检测试验 (RDT)，以便仅针对 GAS 扁桃体炎使用抗生素。我们的目标是进行成本效益分析，比较法国治疗急性扁桃体炎的各种策略。方法：我们使用决策分析模型，包括七种扁桃体炎管理策略（S），特别是儿童和成人： S1：仅观察（参考策略）； S2：临床评分； S3：RDT测试； S4：咽喉培养； S5：临床评分结合RDT检测； S6：RDT检测结合咽喉培养； S7：系统抗生素治疗。有效性的标准是不存在局部化脓性并发症。结果：单独使用 RDT 在成人和儿童中具有最佳的成本效益比。对于这一策略，我们估计儿童每次避免化脓性并发症的成本为 970，成人为 903。对于将确认性咽喉培养与 RDT 相关联的策略，每避免一次化脓性并发症的额外费用估计在儿童中为 106,666 美元，在成人中为 228,000 美元。敏感性分析显示了模型在主要参数变化时的稳定性。结论：对于成人和儿童的急性扁桃体炎，由执业医师进行的 RDT 检测是识别和治疗 GAS 扁桃体炎患者的更有效策略。将 RDT 测试与咽喉培养相结合可以提供额外的有效性，但代价是社区需要支付大量额外费用。
CONTEXT: 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.CONCLUSION: 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.