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

Abstract

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.

2010 Perinatal GBS Prevention Guideline and Resource Utilization

“…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.…”

International Perspectives: Varying International Approaches to Prevention of Neonatal Early-Onset Group B Streptococcal Disease

“…(14) However, for the moment, despite this, national policy remains risk factor-based without universal screening.…”

Use of a decision-analytic model in a health technology assessment: beyond measuring value for money

“…Due to the ever-increasing economic burden of health care globally and the availability of new (but highly expensive) technologies, one of the most frequently asked questions by policymakers in regards to health interventions is whether they provide good value for money relative to alternative interventions. In the previous issue, the well-designed, model-based cost-utility analysis conducted by Ginsberg and his colleagues [1] provides an example of studies that can answer such a question.…”

“…In the study, Ginsberg and colleagues attempt to address the question of whether Israel should expand its coverage of preventive screening against group B streptococcal (GBS) infection to all pregnant women [1]. In doing so, they take the framework of cost-utility analysis (or cost-effectiveness analysis, which is often interchangeably used, but encompasses both types of analyses with and without utility assessment of health outcomes).…”

“…In conducting an ex ante evaluation of universal GBS screening, Ginsberg and colleagues take a model-based approach [1]. They develop a spreadsheet model (implicitly based on a decision-tree structure) and synthesize the best available data into the model to project the costs and health outcomes of the two alternative screening strategies for preventing the burden of GBS disease in Israel.…”