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 screening/risk-based strategy and the current Dutch guideline.


METHODS
Cost-effectiveness analysis based on decision model.


METHODS
Obstetric care system in the Netherlands.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Akker-van Marle
M E
ME
TNO Prevention and Health, Department of Social Pediatrics and Child and Youth Health Care, Leiden, The Netherlands.
Rijnders
M E B
ME
Dommelen
P
P
Fekkes
M
M
Wouwe
J P
JP
Amelink-Verburg
M P
MP
Verkerk
P H
PH
D019072:Antibiotic Prophylaxis / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016133:Polymerase Chain Reaction / Q000191:economics / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics* / Q000517:prevention & control; D011295:Prenatal Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013290:Streptococcal Infections / Q000191:economics* / Q000517:prevention & control; D013292:Streptococcus agalactiae