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

Marle, M. Elske van den Akker-van; Rijnders, Marlies; Dommelen, Paula van; Fekkes, M.; Wouwe, J.P. van; Amelink-Verburg, M.P.; Verkerk, P.H.

doi:10.1111/j.1471-0528.2005.00555.x

Cited by 31 publications

(24 citation statements)

References 18 publications

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“…Further studies using real-time PCR performed in intrapartum setting were needed to identify targeted population and settings where the test will be most useful. In these last years, studies not supporting the intrapartum PCR screening as a cost-effective strategy in comparison with culture screening at around 35-37 weeks of gestation, used data from older less accurate PCR equipment [32,113].…”

Section: Non-culture Methods For Intrapartum Specimen Processingmentioning

confidence: 99%

“…The use of risk-based policy in these nations reflect the belief that their low national incidence of GBS EOD will likely not decrease further with the introduction of universal culture-based screening, and solely increase maternal-fetal exposure to the adverse effects of antibiotics, mainly antimicrobial resistance and potential anaphylactic reactions [30,31]. For these countries, the implementation of universal GBS screening may lead as well to further medicalization of labor and require more counseling and a higher level of care for many more women, increasing costs and increasing the risk of obstetrical interventions [29,32].…”

Section: Current Prevention Strategies Used In European Countries Andmentioning

confidence: 99%

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Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Renzo

Melin²,

Berardi

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

153

135

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Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecologyobstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

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Section: Non-culture Methods For Intrapartum Specimen Processingmentioning

confidence: 99%

Section: Current Prevention Strategies Used In European Countries Andmentioning

confidence: 99%

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Renzo

Melin²,

Berardi

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

153

135

View full text Add to dashboard Cite

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“…Articles were excluded for the following reasons: analysis of a combination of interventions without the possibility to single out the impact of an antibiotic (six articles) or analysis of an intervention that did not include an antibiotic (five articles). The analysis included 23 articles that reported information about 85 incremental cost-utility ratios of antibiotics [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. The characteristics of included cost-utility analyses are described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Health Economics of Antibiotics

Simoens

2010

Pharmaceuticals

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Antibiotics have made a significant contribution to improving patient health, but policy makers and health care payers are concerned about the costs of antibiotics in addition to their effectiveness. This paper aims to assess the value of antibiotics by examining incremental cost-utility ratios of antibiotics. Evidence was derived from cost-utility analyses of antibiotics included in the Tufts-New England Center Cost-Effectiveness Analysis Registry through September 2009. The analysis included 85 incremental cost-utility ratios from 23 cost-utility analyses. The findings showed that 38.8% of incremental cost-utility ratios related to dominant antibiotics (i.e., more effective and less costly than the comparator); 45.9% referred to antibiotics that improved effectiveness, but also increased costs; and 15.3% related to dominated antibiotics (i.e., less effective and more costly than the comparator). The median ratio was 748 € per quality-adjusted life year. Using threshold values of 20,000 € per quality-adjusted life year and 50,000 € per quality-adjusted life year, the probability that an antibiotic provides value for money was 64% and 67%, respectively. The current evidence base suggests that the majority of antibiotics provide value for money and that antibiotics can aid decision makers to attain further population health improvements, whilst containing pharmaceutical expenditures.

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“…Trijbels et al reported that the incidence of neonatal GBS disease fell hardly at all after the introduction of the guideline and recommended a change to the national guideline. In 2005, Van den Akker et al compared the cost-effectiveness of the Dutch guideline with the risk-based strategy, the screening strategy and the combination strategy in a theoretical model [20]. This analysis took into account the unique maternity care system in the Netherlands, which involves a 31% home birth rate and a stratified care model with different professional care providers at different risk levels.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease in the Netherlands

Kolkman

Rijnders

Wouters

et al. 2013

BMC Pregnancy Childbirth

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BackgroundEarly-onset Group B haemolytic streptococcus infection (EOGBS) is an important cause of neonatal morbidity and mortality in the first week of life. Primary prevention of EOGBS is possible with intra-partum antibiotic prophylaxis (IAP.) Different prevention strategies are used internationally based on identifying pregnant women at risk, either by screening for GBS colonisation and/or by identifying risk factors for EOGBS in pregnancy or labour. A theoretical cost-effectiveness study has shown that a strategy with IAP based on five risk factors (risk-based strategy) or based on a positive screening test in combination with one or more risk factors (combination strategy) was the most cost-effective approach in the Netherlands. IAP for all pregnant women with a positive culture in pregnancy (screening strategy) and treatment in line with the current Dutch guideline (IAP after establishing a positive culture in case of pre-labour rupture of membranes or preterm birth and immediate IAP in case of intra-partum fever, previous sibling with EOGBS or GBS bacteriuria), were not cost-effective. Cost-effectiveness was based on the assumption of 100% adherence to each strategy. However, adherence in daily practice will be lower and therefore have an effect on cost-effectiveness.Method/DesignThe aims are to: a.) implement the current Dutch guideline, the risk-based strategy and the combination strategy in three pilot regions and b.) study the effects of these strategies in daily practice. Regions where all the care providers in maternity care implement the allocated strategy will be randomised. Before the introduction of the strategy, there will be a pre-test (use of the current guideline) involving 105 pregnant women per region. This will be followed by a post-test (use of the allocated strategy) involving 315 women per region. The outcome measures are: 1.) adherence to the specific prevention strategy and the determinants of adherence among care providers and pregnant women, 2.) outcomes in pregnant women and their babies and 3.) the costs of each strategy in relation to the effects.DiscussionThis study will provide recommendations for the implementation of the most cost-effective prevention strategy for EOGBS in the Netherlands on the basis of feasibility in daily practice.Trial registrationDutch Trial Register, NTR3965

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

Cited by 31 publications

References 18 publications

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Health Economics of Antibiotics

Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease in the Netherlands

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