Cost‐effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal disease

Objective  To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk‐based strategy, a screening‐based strategy, a combined screeni...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology 2005-06, Vol.112 (6), p.820-826
Main Authors: Akker‐van Marle, M.E., Rijnders, M.E.B., Dommelen, P., Fekkes, M., Wouwe, J.P., Amelink‐Verburg, M.P., Verkerk, P.H.
Format: Article
Language:English
Subjects:
Antibiotic Prophylaxis - economics
Antibiotics
Bacteria
Biological and medical sciences
Child
Child, Preschool
Cost analysis
Cost-Benefit Analysis
Delivery. Postpartum. Lactation
Female
Gynecology. Andrology. Obstetrics
Humans
Infant
Infant, Newborn
Medical sciences
Medical screening
Medical treatment
Polymerase Chain Reaction - economics
Polymerase Chain Reaction - methods
Pregnancy
Pregnancy Complications, Infectious - economics
Pregnancy Complications, Infectious - prevention & control
Prenatal Care - economics
Quality-Adjusted Life Years
Risk Factors
Streptococcal Infections - economics
Streptococcal Infections - prevention & control
Streptococcus agalactiae
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Summary:Objective  To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk‐based strategy, a screening‐based strategy, a combined screening/risk‐based strategy and the current Dutch guideline. Design  Cost‐effectiveness analysis based on decision model. Setting  Obstetric care system in the Netherlands. Population/Sample  Hypothetical cohort of 200,000 neonates. Methods  A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%. Main outcome measures  Cost per quality adjusted of life‐year (QALY). Result  The risk‐based strategy will prevent 352 cases of early‐onset GBS for €5.0 million, indicating a cost‐effectiveness ratio of €7600 per QALY gained. The combined screening risk‐based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening‐based strategy shows the highest reduction in cases of early‐onset GBS, however, at a cost‐effectiveness ratio of €59,300 per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost‐effectiveness ratio. Conclusion  In the Dutch system, the combined screening/risk‐based strategy and the risk‐based strategy have reasonable cost‐effectiveness ratios. If it becomes feasible to add the PCR test, the cost‐effectiveness of the combined screening/risk‐based strategy may even be more favourable.
ISSN:1470-0328
1471-0528
DOI:10.1111/j.1471-0528.2005.00555.x