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An Analysis of the Cost-Effectiveness of Pharyngitis Management and Acute Rheumatic Fever Prevention

RICHARD K. TOMPKINS, M.D.; DANIEL C. BURNES, M.D.; and WILLIAM E. CABLE, B.S.
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Grant support: in part by funds from Contract No. HSM 110-73-403, between Dartmouth College and the National Center for Health Services Research, Department of Health, Education and Welfare; a grant from the National Fund for Medical Education; and Contract No. DADA-11-76-c-0003 between the University of Washington and the Health Services Command, U.S. Army, Department of Defense.

Presented in preliminary form at the Annual Meeting of the American Association of Physicians; 14 May 1975; Atlantic City, New Jersey.

▸Requests for reprints should be addressed to Richard K. Tompkins, M.D.; 1131 Fourteenth Avenue South; Seattle, WA 98114.


Seattle, Washington


Ann Intern Med. 1977;86(4):481-492. doi:10.7326/0003-4819-86-4-481
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The cost-effectiveness of preventing primary acute rheumatic fever attacks by oral or benzathine penicillin treatment was analyzed for both epidemic and endemic streptococcal pharyngitis situations. Decision analysis was used: the probabilities and the outcome values were calculated from published data. Three penicillin strategies were compared: (A) treating only patients with group A streptococci-positive throat cultures; (B) treating all patients; (C) treating none of the patients. In the epidemic situation it is medically most effective and least costly to treat all patients with penicillin (Strategy B). In the endemic situation, Strategy B is also most cost-effective when oral penicillin is used in patient populations where the positive throat culture yield is at least 20%. Strategy A is optimal when the yield is between 5% and 20%; below a 5% yield, Strategy C is appropriate. For any individual patient, it is possible that choice of the most cost-effective treatment strategy could be based on the patient's clinical findings.

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