Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization

Turrentine, Mark A.; Ramírez, Mildred; Mastrobattista, Joan M.

doi:10.1155/2009/934698

Cited by 17 publications

(9 citation statements)

References 40 publications

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“…A Dutch study [35] found a combined screening and risk-based study to be very cost-effective, while for screening alone the cost per QALY was around twice the GNP per head, rendering it just cost-effective. In addition, a recent USA article suggests that universal treatment of term pregnancies with a prior history of GBS colonization is more cost-effective than a strategy of screening and treating based on positive culture results [36]. …”

Section: Discussionmentioning

confidence: 99%

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Ginsberg

Eidelman

Shinwell

et al. 2013

Isr J Health Policy Res

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BackgroundIn Israel, an average of 37 children are born each year with sepsis and another four with meningitis as a result of Group B Streptococcal (GBS) disease. Israel currently only screens mothers with defined risk factors (around 15% of all pregnancies) in order to identify candidates for Intrapartum Antiobiotic Prophyhlaxis (IAP) of GBS. This paper presents a cost-utility analysis of implementing an alternative strategy, which would expand the current protocol to one aiming to screen all pregnant women at 35–37 weeks gestation based on taking a vaginal culture for GBS.MethodsA spreadsheet model was built incorporating technical, epidemiological, health service costs, demographic and economic data based primarily on Israeli sources.ResultsThe intervention of universal screening (compared with the current scenario) would increase screening costs from 580,000 NIS to 3,278,000 million NIS. In addition, the intervention would also increase penicillin costs from 39,000 NIS to 221,000 NIS. Current culture screening of approximately 15% of mothers-to-be with high risk factors resulted in 42 GBS births in 2008-9 (0.253/1000 births). Expanding culture screening to 85% of mothers-to-be, will decrease the number of GBS births to 17.3 (0.104/1000 births). The initial 2.9 million NIS incremental intervention costs are offset by decreased treatment costs of 1.9 million NIS and work productivity gains of 811,000 NIS as a result of a decrease in neurological sequelae from GBS caused meningitis. Thus the resultant net cost of the intervention is only around 134,000 NIS. Culture based screening will reduce the burden of disease by 12.6 discounted Quality Adjusted Life Years (QALYS), giving a very cost effective baseline incremental cost per QALY (cf. risk factor screening) of 10,641 NIS per QALY. The data was very sensitive to rates of anaphylactic shock and changes in the percentage of meningitis cases that had associated long term-sequelae.ConclusionIt is recommended that Israel adopt universal culture-based GBS screening.

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Section: Discussionmentioning

confidence: 99%

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Ginsberg

Eidelman

Shinwell

et al. 2013

Isr J Health Policy Res

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“…A strategy providing intrapartum chemoprophylaxis without prior screening to all women who were GBS-colonized in a previous pregnancy was evaluated hypothetically in a decision analysis, finding that culture avoidance and uniform treatment might be cost-effective. 20 However, that study took into account only two prior small studies to determine the risk of recurrent colonization. The study was further limited by the use of manufacturer's suggested price instead of actual drug prices for penicillin and by the assumption that all patients would be treated with penicillin instead of ampicillin or other antibiotics in the setting of penicillin allergy.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of group B streptococcus colonization in successive pregnancies

Colicchia

Lauderdale

et al. 2014

J Perinatol

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“…Previous economic studies of neonatal EOS have focused on the costs associated with maternal screening, intrapartum prophylaxis, or neonatal GBS disease [24][25][26][27][28] with little attention to the costs of neonatal evaluation. The resources expended over the study periods among asymptomatic infants at risk for EOS were considerable; more than 2200 nursing hours were required to evaluate 1396 infants, including 890 uninfected infants treated with antibiotics, at an estimated cost of nearly $400 000.…”

Section: Discussionmentioning

confidence: 99%

2010 Perinatal GBS Prevention Guideline and Resource Utilization

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: An algorithm for neonatal early-onset sepsis risk based on Centers for Disease Control and Prevention 2002 guidelines for prevention of perinatal Group B Streptococcus disease results in the evaluation of ∼12-15% of well-appearing term and late preterm infants. WHAT THIS STUDY ADDS:A revised algorithm based on the Centers for Disease Control and Prevention 2010 guidelines eliminated 25% of all early-onset sepsis evaluations and resulted in significant cost savings, without short-term evidence of harm. abstract OBJECTIVES: To quantify differences in early-onset sepsis (EOS) evaluations, evaluation-associated resource utilization, and EOS cases detected, when comparing time periods before and after the implementation of an EOS algorithm based on the Centers for Disease Control and Prevention (CDC) 2010 guidelines for prevention of perinatal Group B Streptococcus (GBS) disease. METHODS:Retrospective cohort study of infants born at $36 weeks' gestation from 2009 to 2012 in a single tertiary care center. One 12-month period during which EOS evaluations were based on the CDC 2002 guideline was compared with a second 12-month period during which EOS evaluations were based on the CDC 2010 guideline. A cost minimization analysis was performed to determine the EOS evaluation-associated costs and resources during each time period.RESULTS: During the study periods, among well-appearing infants $36 weeks' gestation, EOS evaluations for inadequate GBS prophylaxis decreased from 32/1000 to ,1/1000 live births; EOS evaluationassociated costs decreased by $6994 per 1000 live births; and EOS evaluation-associated work hours decreased by 29 per 1000 live births. We found no increase in EOS evaluations for other indications, total NICU admissions, frequency of infants evaluated for symptoms before hospital discharge, or incidence of EOS during the 2 study periods.CONCLUSIONS: Implementation of an EOS algorithm based on CDC 2010 GBS guidelines resulted in a 25% decrease in EOS evaluations performed among well-appearing infants $36 weeks' gestation, attributable to decreased evaluation of infants born in the setting of inadequate indicated GBS prophylaxis. This resulted in significant changes in EOS evaluation-associated resource expenditures. Dr Mukhopadhyay designed the study, designed the data collection instruments, collected and analyzed the data, and drafted the initial manuscript; Dr Dukhovny designed the cost minimization study design, analyzed the data for the cost calculations, and reviewed and revised the manuscript; Ms Mao conducted bootstrapping and sensitivity analysis for the study; Dr Eichenwald conceptualized the study question, reviewed the analysis and conclusions, and reviewed and revised the manuscript; Dr Puopolo conceptualized and designed the study, reviewed the data collection instruments, reviewed the data analysis and conclusions, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization

Cited by 17 publications

References 40 publications

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Recurrence of group B streptococcus colonization in successive pregnancies

2010 Perinatal GBS Prevention Guideline and Resource Utilization

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