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Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness

Last updated: May 31, 2018
Project Number: RD0046-000
Product Line: Rapid Response
Research Type: Other Diagnostics
Report Type: Peer-reviewed summary with critical appraisal
Result type: Report

Question

  1. What is the diagnostic test accuracy of non-culture-based tests for the diagnosis of suspected group A strep infection?
  2. What is the clinical utility of non-culture-based tests for the diagnosis of suspected group A strep infection?
  3. What is the safety of non-culture-based tests for the diagnosis of suspected group A strep infection?
  4. What is the cost-effectiveness of non-culture-based diagnostic tests for suspected group A strep infection?

Key Message

From systematic reviews and observational studies the sensitivity values ranged between 82% and 100% for molecular assays and between 55% and 94% for immunoassays. Specificities for the two test types were 91% to 99% for molecular assays and 81% to 100% for immunoassays. One pragmatic adaptive RCT showed no clear advantage of rapid antigen test over clinical score for management of group a streptococcus infection. Evidence regarding change in treatment strategy with respect to use of antibiotics resulting from use of rapid antigen detection tests for diagnosis is conflicting.No evidence was available regarding adverse effects associated with the non-culture-based tests.One cost-effectiveness analysis suggested that compared to diagnosis using rapid antigen test, diagnosis using medical scores was more cost-effective. However, results of the corresponding cost-utility analysis were less clear.