Modalities of group A streptococcal prevention and treatment and their economic justification

Infection by group A Streptococcus (Strep A) results in a diverse range of clinical conditions, including pharyngitis, impetigo, cellulitis, necrotising fasciitis, and rheumatic heart disease. This article outlines recommended strategies for Strep A treatment and prevention and reviews the literature for economic evaluations of competing treatment and prevention strategies. Most economic evaluations focus on reducing the duration of illness or the risk of rheumatic fever among people presenting with sore throat via diagnostic and/or treatment strategies. Few studies have evaluated strategies to reduce the burden of Strep A infection at a population level or considered local capacity to finance and implement strategies. Evaluation of validated costs and consequences for a wider range of Strep A interventions is needed to ensure policies maximise patient outcomes under budget constraints, including attention to basic public health strategies and emerging strategies such as vaccination.