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

Kolkman DG, Rijnders ME, Wouters MG, van den Akker-van Marle ME, van der Ploeg CK, de Groot CJ, Fleuren MA - BMC Pregnancy Childbirth (2013)

Bottom Line: Cost-effectiveness was based on the assumption of 100% adherence to each strategy.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.This 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands. diny.kolkman@tno.nl.

ABSTRACT

Background: Early-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/design: The 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.

Discussion: This 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 registration: Dutch Trial Register, NTR3965.

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Related in: MedlinePlus

Framework representing the innovation process and related categories of determinants [23].
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3733882&req=5

Figure 1: Framework representing the innovation process and related categories of determinants [23].

Mentions: FigureĀ 1 shows the four main stages in innovation processes. In the dissemination stage, the innovation should reach every professional. In the adoption stage, the professional develops positive or negative intentions about using the innovation. In the implementation stage, the professional tries to use the innovation in daily practice and finds out what working with the innovation actually means. In the final stage, the continuation stage, working with the innovation either becomes routine practice or not.


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

Kolkman DG, Rijnders ME, Wouters MG, van den Akker-van Marle ME, van der Ploeg CK, de Groot CJ, Fleuren MA - BMC Pregnancy Childbirth (2013)

Framework representing the innovation process and related categories of determinants [23].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3733882&req=5

Figure 1: Framework representing the innovation process and related categories of determinants [23].
Mentions: FigureĀ 1 shows the four main stages in innovation processes. In the dissemination stage, the innovation should reach every professional. In the adoption stage, the professional develops positive or negative intentions about using the innovation. In the implementation stage, the professional tries to use the innovation in daily practice and finds out what working with the innovation actually means. In the final stage, the continuation stage, working with the innovation either becomes routine practice or not.

Bottom Line: Cost-effectiveness was based on the assumption of 100% adherence to each strategy.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.This 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands. diny.kolkman@tno.nl.

ABSTRACT

Background: Early-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/design: The 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.

Discussion: This 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 registration: Dutch Trial Register, NTR3965.

Show MeSH
Related in: MedlinePlus