title: Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis.
abstract: OBJECTIVE
  To compare the cost-effectiveness of an additional 24-hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS)-colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24-hour in-hospital observation.
  
  
  METHODS
  Cost-effectiveness analysis from a societal perspective.
  
  
  METHODS
  United States.
  
  
  METHODS
  Asymptomatic term neonates born to GBS-colonised mothers with IAP after an initial 24-hour in-hospital observation.
  
  
  METHODS
  Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long-term health sequelae.
  
  
  METHODS
  Expected cost and quality-adjusted life years (QALYs), Incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005-0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13-1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89-24,407,017.82). The proportion of early-onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long-term sequelae following prompt versus delayed treatment play important roles in determining the cost-effectiveness of delayed hospital discharge.
  
  
  CONCLUSIONS
  Cost-effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Health System, L4000 Women’s Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5276, USA. mitcberg@umich.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Berger
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.forename: J A
authors.initials: JA
authors.lastname: Williams
authors.forename: C J M
authors.initials: CJ
authors.lastname: Van de Ven
authors.forename: E L
authors.initials: EL
authors.lastname: Mozurkewich
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics*; D009035:Mothers; D010351:Patient Discharge / Q000191:economics*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents