ASSESSMENT OF A TREATMENT POLICY ACCORDING TO COST-EFFICIENCY RATIO

Assessment of cost-efficiency is one of the most operating arguments to rationalize medical prescriptions. The example is the prevention of acute rheumatic fever (ARF) by the treatment of pharyngitis in children 4-15 years old, with benzathin-penicillin (Extencilline(R)). The baseline risk of ARF in this population was estimated to be 3 per 100 streptococcal pharyngitis. Two preventive policies were compared : either the treatment of all pharyngitis with a shot of penicillin, or the selective treatment depending on the positive result of the throat culture. The last policy has the better cost-effectiveness ratio, unless the cost of the penicillin shot is less than 17.5 FF. The marginal cost-effectiveness ratio is inversely proportional to the risk of ARF in the population : this ratio is extremely high in the metropolitan pediatric French population where the incidence of ARF is quite low in the present time.