Limits...
Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

Turrentine MA, Ramirez MM, Mastrobattista JM - Infect Dis Obstet Gynecol (2009)

Bottom Line: A decision analysis model was used to compare costs and outcomes.When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710).Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Kelsey Research Foundation, University of Texas Medical School, Houston, TX 77007, USA. drt318@aol.com

ABSTRACT

Objective: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy.

Study design: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis.

Results: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710).

Conclusion: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

Show MeSH

Related in: MedlinePlus

Decision-analysis model for evaluating the cost-effectiveness of screening-directed versus universal treatment of women with group B streptococci (GBS) colonization in a previous pregnancy on prevention of early onset neonatal GBS sepsis.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2801019&req=5

fig1: Decision-analysis model for evaluating the cost-effectiveness of screening-directed versus universal treatment of women with group B streptococci (GBS) colonization in a previous pregnancy on prevention of early onset neonatal GBS sepsis.

Mentions: We constructed a decision-analysis model to evaluate the cost-effectiveness of screening-directed versus universal treatment for the prevention of early onset neonatal GBS sepsis in women colonized with GBS in a previous pregnancy. The pathways of events are shown in Figure 1. Since our objective is to compare screening-directed versus direct treatment, we limited our cost analysis to term gestations (37 weeks and above) and excluded women with indications for intrapartum prophylaxis (previous neonate with invasive GBS disease, GBS bacteriuria in the current pregnancy, and unknown GBS status in conjunction with any of the following amniotic membrane rupture for 18 hours or more and intrapartum temperature 38.0°C or more) [1]. Since current recommendations are for culture-based screening at 35 to 37 weeks of gestation, we did not perform a subgroup analysis for a rapid GBS test result at presentation in labor [1].


Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

Turrentine MA, Ramirez MM, Mastrobattista JM - Infect Dis Obstet Gynecol (2009)

Decision-analysis model for evaluating the cost-effectiveness of screening-directed versus universal treatment of women with group B streptococci (GBS) colonization in a previous pregnancy on prevention of early onset neonatal GBS sepsis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2801019&req=5

fig1: Decision-analysis model for evaluating the cost-effectiveness of screening-directed versus universal treatment of women with group B streptococci (GBS) colonization in a previous pregnancy on prevention of early onset neonatal GBS sepsis.
Mentions: We constructed a decision-analysis model to evaluate the cost-effectiveness of screening-directed versus universal treatment for the prevention of early onset neonatal GBS sepsis in women colonized with GBS in a previous pregnancy. The pathways of events are shown in Figure 1. Since our objective is to compare screening-directed versus direct treatment, we limited our cost analysis to term gestations (37 weeks and above) and excluded women with indications for intrapartum prophylaxis (previous neonate with invasive GBS disease, GBS bacteriuria in the current pregnancy, and unknown GBS status in conjunction with any of the following amniotic membrane rupture for 18 hours or more and intrapartum temperature 38.0°C or more) [1]. Since current recommendations are for culture-based screening at 35 to 37 weeks of gestation, we did not perform a subgroup analysis for a rapid GBS test result at presentation in labor [1].

Bottom Line: A decision analysis model was used to compare costs and outcomes.When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710).Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Kelsey Research Foundation, University of Texas Medical School, Houston, TX 77007, USA. drt318@aol.com

ABSTRACT

Objective: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy.

Study design: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis.

Results: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710).

Conclusion: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

Show MeSH
Related in: MedlinePlus