Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results

V. Sintchenko, G. L. Gilbert, E. Coiera, D. Dwyer

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: neuraminidase (NA) inhibitors have recently become available for treatment of influenza. Rapid antigen detection assays at 'point-of-care' may improve the accuracy of clinical diagnosis, but the value of these techniques in assisting with the appropriate use of antivirals remains controversial. Objective: to compare the diagnostic utilities of two management strategies for influenza, empirical antiviral therapy versus therapy based on a positive rapid test result in pre-epidemic and epidemic periods. Study design: a threshold decision analytic model was designed to compare these competing strategies and sensitivity analysis performed to examine the impact of diagnostic variables on the expected utility of the decision with a range of prior probabilities of infection between 1 and 50%. Results: on the basis of the calculated sensitivity (77%) and specificity (95%) of a point-of-care test for influenza, pre-treatment testing was preferred and cost-effective in non-epidemic stage of the influenza cycle. The alternative strategy of empirical treatment produces a higher utility value during epidemics, but may result in overuse of antivirals for low-risk populations. The two strategies had equivalent efficacy when the probability of influenza was 42%. Conclusions: Patients with flu-like illness, who present outside the influenza outbreak and are considered to be at low risk for influenza-related complications, should be tested to confirm the diagnosis before starting antiviral treatment with a NA inhibitor. The most important variables in the model were the accuracy of the clinical diagnosis and the pre-test probability of influenza. A threshold probability of influenza of 42% would dictate changing from the rapid testing strategy to a 'treat regardless' strategy.

LanguageEnglish
Pages15-21
Number of pages7
JournalJournal of Clinical Virology
Volume25
Issue number1
DOIs
Publication statusPublished - 2002
Externally publishedYes

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Decision Support Techniques
Virus Diseases
Orthomyxoviridae
Human Influenza
Antiviral Agents
Point-of-Care Systems
Therapeutics
Neuraminidase
Disease Outbreaks
Antigens
Costs and Cost Analysis
Sensitivity and Specificity

Keywords

  • Decision analysis
  • Influenza
  • Laboratory diagnosis
  • Treatment

Cite this

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title = "Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results",
abstract = "Background: neuraminidase (NA) inhibitors have recently become available for treatment of influenza. Rapid antigen detection assays at 'point-of-care' may improve the accuracy of clinical diagnosis, but the value of these techniques in assisting with the appropriate use of antivirals remains controversial. Objective: to compare the diagnostic utilities of two management strategies for influenza, empirical antiviral therapy versus therapy based on a positive rapid test result in pre-epidemic and epidemic periods. Study design: a threshold decision analytic model was designed to compare these competing strategies and sensitivity analysis performed to examine the impact of diagnostic variables on the expected utility of the decision with a range of prior probabilities of infection between 1 and 50{\%}. Results: on the basis of the calculated sensitivity (77{\%}) and specificity (95{\%}) of a point-of-care test for influenza, pre-treatment testing was preferred and cost-effective in non-epidemic stage of the influenza cycle. The alternative strategy of empirical treatment produces a higher utility value during epidemics, but may result in overuse of antivirals for low-risk populations. The two strategies had equivalent efficacy when the probability of influenza was 42{\%}. Conclusions: Patients with flu-like illness, who present outside the influenza outbreak and are considered to be at low risk for influenza-related complications, should be tested to confirm the diagnosis before starting antiviral treatment with a NA inhibitor. The most important variables in the model were the accuracy of the clinical diagnosis and the pre-test probability of influenza. A threshold probability of influenza of 42{\%} would dictate changing from the rapid testing strategy to a 'treat regardless' strategy.",
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Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results. / Sintchenko, V.; Gilbert, G. L.; Coiera, E.; Dwyer, D.

In: Journal of Clinical Virology, Vol. 25, No. 1, 2002, p. 15-21.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results

AU - Sintchenko, V.

AU - Gilbert, G. L.

AU - Coiera, E.

AU - Dwyer, D.

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