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

Objective: To determine 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 analysis 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 strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be 60 pounds, 700 and 473 pounds, 600, respectively. The number needed to treat to prevent one sepsis would be 1,087 with a risk factors strategy and 1,029 with a screening strategy. Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively.
Conclusions: Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.