article is a medical decision analysis utilizing newest sensitivity/specificity
data of rapid strep test optical immunoassays (OIA) and incidence
of rheumatic fever to determine cost-effectiveness of different
diagnostic strategies: treat all vs. culture vs. OIA test vs.
OIA with culture confirmation.
Current OIAs have higher sensitivity than original rapid strep
tests (77-97% vs 50-70%). Based
on weighted average of 13 published studies, the performance of
the "gold standard" (blood agar culture, sensitivity 83.4%) now
appears no better/equivalent to high sensitivity immunoassays
Sensitivity analysis finds the decision "sensitive" to rapid test
performance, prevalence of GABHS (summer vs. winter), and incidence
of rheumatic fever.
At a probability of acute rheumatic fever of 0.58% (580/100,000),
OIA plus culture is more cost-effective than OIA alone; at a probability
of ARF of 0.16%, OIA plus culture is more cost-effective than
At a sensitivity of OIA of <82%, culture alone is more cost-effective.
At a cost of antibiotics of $15.05, culture is more cost-effective