Kosteneffectiviteitsanalyse van verschillende strategieën ter preventie van neonatale infectie met groep B-streptokokken

To assess the cost effectiveness of four strategies in the prevention of neonatal infection with group-B streptococci (GBS).

Design

Cost-effectiveness analysis.

Method

A modelling study was carried out in which the effects and the costs of intrapartum antibiotic prophylaxis (IAP) in accordance with the guideline from the Dutch Association of Obstetrics and Gynaecology and the Dutch Association of Paediatrics (IAP in case of the risk factors fever, bacteriuria caused by GBS or a previous GBS-infected child and IAP in case of the risk factors premature birth and protracted ruptured membranes, on the basis of culture results or the clinical judgement of the physician) were compared to the effects and the costs of a risk strategy (directly IAP in case of any of the 5 mentioned risk factors), a screening strategy (screening and subsequent IAP in women with GBS or an unknown GBS status) and a combination strategy (screening and subsequent IAP in women with GBS and a risk factor, and in women with unknown GBS status and a risk factor) in a hypothetical cohort of 200,000 bearing women.

Results

The risk strategy would prevent 352 cases of perinatal GBS infection at a cost of approximately EUR 5 m indicating a cost-effectiveness ratio of EUR 7,600 per quality-adjusted life year (QALY) gained. The combination strategy would have comparable results. These strategies dominated the guideline, which was less effective at a higher cost. The screening strategy was shown to be the most effective by preventing 470 perinatal GBS infections, but due to considerable costs led to an unfavourable cost-effectiveness ratio. Introducing the real time-polymerase chain reaction (PCR) test into the combination strategy during labour would lead to the most favourable cost-effectiveness ratio.

Conclusion

In the Dutch system the risk strategy and the combination strategy seemed to be reasonably cost-effective. However to assess their real cost effectiveness, the performance of both strategies should be determined in clinical practice. The feasibility of alternative strategies should be further explored in choosing the strategy most applicable to Dutch clinical practice.

Ned Tijdschr Geneeskd. 2007;151:189-93