Cost and effectiveness analysis of the diagnostic and therapeutic approaches of group A Streptococcus pharyngitis management in Iran

BACKGROUND: A sore throat is one of the common causes behind visits to the physician and antibiotic overtreatment in the world, especially in Iran. There are six ways of approaching pharyngitis patients. It is necessary to perform a cost-effectiveness analysis and find the best approach in all situations on group A streptococcus (GAS) pharyngitis management to propose a pharyngitis guideline. METHOD: The decision tree of managing pharyngitis and its complications was drawn. The probability of every status and the branches of the tree were derived from the literature, and the cost of related diseases and complications were calculated based on the dossiers of the patients in two main pediatric central hospitals in Tehran, Iran. Further, cost-effectiveness, sensitivity, and threshold analyses were conducted to find out the best management strategy. Moreover, for a situation analysis of pharyngitis management in Iran, a questionnaire was designed and given to general practitioners and pediatricians; 130 subjects responded to it. The results were then analyzed. RESULTS: The rapid test antigen (RTA) and culture strategy were proved to have the highest effect on the quality-adjusted life year. In addition, a less expensive strategy was solely observed to be the RTA. The worst effect gained (most quality-adjusted lost days) was, however, from the “treat none” strategy. CONCLUSION: According to our cost-effectiveness analysis, the best management of pharyngitis occurs in RTA alone, followed slightly by culture strategies; the “RTA then culture if needed” and “RTA and culture” approaches become possible options after them. The “treat all” and “treat none” approaches, however, were not proper strategies in any case.