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Preventive strategies for group B streptococcal and other bacterial infections in early infancy: cost effectiveness and value of information analyses

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39325.681806.AD (Published 27 September 2007) Cite this as: BMJ 2007;335:655
  1. Tim E Colbourn, research fellow1,
  2. Christian Asseburg, research fellow2,
  3. Laura Bojke, research fellow2,
  4. Zoe Philips, lecturer3,
  5. Nicky J Welton, senior research fellow in medical statistics4,
  6. Karl Claxton, professor2,
  7. A E Ades, professor4,
  8. Ruth E Gilbert, professor1
  1. 1Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH
  2. 2Centre for Health Economics, University of York, York YO10 5DD
  3. 3School of Economics, University of Nottingham, Nottingham NG7 2UH
  4. 4MRC Health Services Research Collaboration, University of Bristol, Bristol BS8 2PR
  1. Correspondence to: R E Gilbert r.gilbert{at}ich.ucl.ac.uk
  • Accepted 28 August 2007

Abstract

Objective To determine the cost effectiveness of strategies for preventing neonatal infection with group B streptococci and other bacteria in the UK and the value of further information from research.

Design Use of a decision model to compare the cost effectiveness of prenatal testing for group B streptococcal infection (by polymerase chain reaction or culture), prepartum antibiotic treatment (intravenous penicillin or oral erythromycin), and vaccination during pregnancy (not yet available) for serious bacterial infection in early infancy across 12 maternal risk groups. Model parameters were estimated using multi-parameter evidence synthesis to incorporate all relevant data inputs.

Data sources 32 systematic reviews were conducted: 14 integrated results from published studies, 24 involved analyses of primary datasets, and five included expert opinion.

Main outcomes measures Healthcare costs per quality adjusted life year (QALY) gained.

Results Current best practice (to treat only high risk women without prior testing for infection) and universal testing by culture or polymerase chain reaction were not cost effective options. Immediate extension of current best practice to treat all women with preterm and high risk term deliveries without testing (11% treated) would result in substantial net benefits. Currently, addition of culture testing for low risk term women, while treating all preterm and high risk term women, would be the most cost effective option (21% treated). If available in the future, vaccination combined with treating all preterm and high risk term women and no testing for low risk women would probably be marginally more cost effective and would limit antibiotic exposure to 11% of women. The value of information is highest (£67m) if vaccination is included as an option.

Conclusions Extension of current best practice to treat all women with preterm and high risk term deliveries is readily achievable and would be beneficial. The choice between adding culture testing for low risk women or vaccination for all should be informed by further research. Trials to evaluate vaccine efficacy should be prioritised.

Footnotes

  • We thank the following contributors to this project: Mark Sculpher and Khalid Khan helped design the study; Carol Baker, Jim Gray, David Isaacs, Sara Kenyon, Mike Millar, and Deirdre Murphy were expert advisers; Mark Little, Phil Steer, Paul Heath, Sam Oddie, Nick Embleton, Georgia Duckworth, Catherine Goodall, Dominique Acolet, Mike Millar, Sian Harding, Paul Ostro, Helen Bedford, Sue Halket, and John De Louvois contributed primary datasets.

  • Contributors: REG, AEA, and KC conceived the study. TEC and REG carried out the systematic reviews. KC, CA, LB, and ZP undertook the economic analyses. CA, AEA, and NJW carried out the evidence synthesis analyses. REG, TEC, KC, and AEA drafted the initial report, which was commented on by all authors. REG coordinated the study and is the guarantor.

  • Funding: The study was funded by the UK Department of Health through its Health Technology Assessment Programme. The opinions and conclusions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health.

  • Competing interests: None declared.

  • Accepted 28 August 2007
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