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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. · Amelink-Verburg, M.P. · Verkerk, P.H.
Type:article
Date:2006
Institution: TNO Kwaliteit van Leven
Source:BJOG: An International Journal of Obstetrics and Gynaecology, 3, 113, 360-361
Identifier: 239164
doi: doi:10.1111/j.1471-0528.2006.00855.x
Keywords: Health · Jeugd en Gezondheid · Antibiotic agent · Chlorhexidine · Ambulance · Antibiotic prophylaxis · Clinical research · Cost effectiveness analysis · Health care financing · Human · Infection prevention · Infection rate · Infection risk · Intrapartum care · Letter · Newborn period · Patient transport · Polymerase chain reaction · Premature labor · Register · Risk assessment · Risk factor · Sepsis · Streptococcus agalactiae · Streptococcus infection · Vaginal lavage

Abstract

COBJECTIVE: 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 Euros, indicating a cost-effectiveness ratio of 7600 Euros 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 Euros 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. hemicals / CAS: chlorhexidine, 3697-42-5, 55-56-1