Choosing a strategy to prevent neonatal early-onset group B streptococcal sepsis: economic evaluation

Objective To determined the most appropriate, strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease. Design Decision analysis and economic evaluation. Setting Geneva University Hospitals, Switzerland. Population Pregnant women at 35-37 weeks of gestation and in labour. Methods Local data and data from the literature were used in a decision ana lysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies. Main outcome measures Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour. Results Compared with the current policy, the risk factors strateg would pr event 69 streptococcal sepsis per ly million deliveries and the screening s trategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be pound 60, 700 and pound 473, 600, respectively . The number needed to treat to prevent one sepsis would be 1087 with a ris k factors strategy and 1029 with a screening strategy. Preventive strategie s would increase the, proportion of women receiving antibiotics during labo ur from 6% with the current policy, to 13.5% and 16.5% respectively. Conclusions Preventive strategies are more effective than the current polic y, but imply increased hospital costs and a notable increase in the proport ion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.