Rapid antigen detecting tests
Topic Status Complete
Rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community pharmacy setting
Specialities: Infectious disease
This is an updated version of an appraisal. HTW originally issued guidance on this topic in September 2020. The guidance and supporting documents from previous appraisals are available from HTW upon request.
Outcome of the appraisal
NHS Wales should routinely offer rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community pharmacy setting.
Evidence shows antibiotic prescribing rates are lower for people presenting with a sore throat at community pharmacies providing a screening and treatment service using confirmatory point-of-care rapid antigen detection tests (RADTs) for group A streptococcal (GAS) infections, compared to 1) community pharmacies that do not use confirmatory RADTs or to 2) standard consultations at a general practice. This is important because inappropriate prescribing of antibiotics can contribute to antimicrobial resistance.
Using RADTs in community pharmacies for people presenting with a sore throat was estimated to be cost effective compared to standard general practitioner (GP) assessment. Cost effectiveness was uncertain compared to community pharmacies not using RADTs, because the wider health benefits of reducing antibiotic prescribing, such as impacts on antimicrobial resistance, could not be robustly captured in the economic modelling. However, the Appraisal Panel felt that the wider health benefits of reducing antibiotic prescribing are important and judged that the likely benefits from introducing RADT outweigh the remaining uncertainty about its cost effectiveness.
Why was this topic appraised?
Most cases of sore throat are due to viral infections, but a minority are caused by bacterial infection and may benefit from antibiotics. The most common bacterial cause of sore throat is GAS. RADTs for GAS sore throat are point-of-care tests that can be used to help with the diagnosis of sore throat.
The Wales Sore Throat Test and Treat Service (STTT) is a service run by community pharmacies that has piloted the use of confirmatory RADTs in people with higher likelihood of GAS sore throat after assessment using clinical scoring tools, such as FeverPAIN or Centor. In 2020, an HTW appraisal of the clinical and cost effectiveness of RADTs for GAS sore throat in the STTT found that the evidence was limited and did not support routine adoption. Further research has now been conducted. RADTs have been used in the STTT since 2018 when the service was piloted in 56 community pharmacies. The STTT has been rolled out nationally across Wales and in 2024/2025 around 40,000 RADTs were conducted. The aim of the re-assessment was to enable a final decision to be taken regarding ongoing use of RADTs as part of the STTT service.
This topic was proposed by the Chief Pharmaceutical Officer, Welsh Government.
Plain language summary
What are group A streptococcal infections?
Group A streptococcus (Strep A) is a bacterial infection that causes symptoms like sore throat, fever and aches and pains. Strep A can be treated with antibiotics. Not all cases of a sore throat will be because of strep A. Other causes of sore throat will not need antibiotic treatment.
Determining the cause of the sore throat will prevent overprescription of antibiotics. This is important because the more antibiotics are prescribed, the more bacteria can develop resistance to antibiotics.
What are rapid antigen detection tests?
Rapid antigen detection tests (RADTs) can be used to identify cases of strep A. A swab is taken at the back of the throat and is tested for the presence of antigens specific to strep A. The test can be administered by pharmacists. This means that people with a sore throat will not need to make an appointment with their GP to be tested for strep A and prescribed antibiotics.
What did Health Technology Wales do?
HTW looked for evidence on the use of RADTs for sore throats. NHS Wales should routinely offer rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community.
Guidance
GUI020-2 07.2026
Evidence Appraisal Report
EAR020-2 07.2026
Health Technology Wales Partners
