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

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Author: Akker-van Marle, M.E. van den · Rijnders, M.E.B. · Dommelen, P. van · Fekkes, M. · Wouwe, J.P. van · Amelink-Verburg, M.P. · Verkerk, P.H.
Type:article
Date:2005
Source:BJOG: An International Journal of Obstetrics and Gynaecology, 6, 112, 820-826
Identifier: 238537
doi: doi:10.1111/j.1471-0528.2005.00555.x
Keywords: Health · Antibiotic agent · Bacterium detection · Cohort analysis · Controlled study · Cost effectiveness analysis · Decision making · Health care cost · Health survey · Mass screening · Netherlands · Newborn · Obstetric care · Patient care · Practice guideline · Risk assessment · Antibiotic Prophylaxis · Child · Child, Preschool · Cost-Benefit Analysis · Female · Humans · Infant · Infant, Newborn · Polymerase Chain Reaction · Pregnancy · Pregnancy Complications, Infectious · Prenatal Care · Quality-Adjusted Life Years · Risk Factors · Streptococcal Infections · Streptococcus agalactiae

Abstract

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. © RCOG 2005.