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Early hospital discharge of infants born to group B streptococci‐positive mothers: a decision analysis
Author(s) -
Berger MB,
Xu X,
Williams JA,
Van de Ven CJM,
Mozurkewich EL
Publication year - 2012
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2011.03249.x
Subject(s) - medicine , asymptomatic , sepsis , pediatrics , group b , cost effectiveness analysis , cost effectiveness , quality adjusted life year , risk analysis (engineering)
Please cite this paper as: Berger M, Xu X, Williams J, Van de Ven C, Mozurkewich E. Early hospital discharge of infants born to group B streptococci‐positive mothers: a decision analysis. BJOG 2012;119:439–448. Objective To compare the cost‐effectiveness of an additional 24‐hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS) ‐colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24‐hour in‐hospital observation. Design Cost‐effectiveness analysis from a societal perspective. Setting United States. Population Asymptomatic term neonates born to GBS‐colonised mothers with IAP after an initial 24‐hour in‐hospital observation. Methods Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long‐term health sequelae. Main outcome measures Expected cost and quality‐adjusted life years (QALYs), Incremental cost‐effectiveness ratio (ICER). Results Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005–0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13–1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89–24,407,017.82). The proportion of early‐onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long‐term sequelae following prompt versus delayed treatment play important roles in determining the cost‐effectiveness of delayed hospital discharge. Conclusion Cost‐effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation.