Kekki Minnamaija, Kurki Tapio, Kotomäki Teija, Sintonen Harri, Paavonen Jorma
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Central Hospital, PO Box 140, Haartmaninkatu 2, FIN-00290 HUS, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2004 Jan;83(1):27-36. doi: 10.1111/j.1600-0412.2004.00262.x.
Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10-30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery.
A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses.
There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%.
Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.
细菌性阴道病（BV）是早产的一个重要危险因素。在10%-30%的孕妇中可检测到BV，且通常无症状。孕期治疗BV似乎可降低高危女性早产的风险。我们对早产低风险无症状女性在孕早期进行BV筛查和治疗进行了成本效益分析。
构建了一个有两个分支的决策树。对于筛查（及治疗）分支，概率来自我们早期关于BV筛查和治疗的随机试验，该试验包括用阴道克林霉素乳膏或安慰剂治疗的BV阳性女性以及BV阴性孕妇。这些女性的结局概率从产前诊所记录和医院记录中收集，而对于不筛查分支，主要从芬兰围产期统计数据中收集。所考虑的结局包括早产、分娩方式、围产期感染和产后并发症。与这些结局相关的单位成本主要基于疾病相关分组（DRGs）。将不筛查与两个筛查方案（一个用克林霉素，另一个用甲硝唑治疗）进行比较，并进行敏感性分析。
筛查和不筛查策略在成本和早产率方面无显著差异，但筛查策略导致的围产期感染和产后并发症显著减少。敏感性分析表明，如果早产率超过3%，筛查策略可能会节省成本。
与早产低风险人群不进行筛查相比，孕早期对BV进行筛查和治疗可能不会降低成本，但在相同成本下，就减少围产期感染和产后并发症而言会产生更多健康效益。然而，如果早产率高于3%，则可能节省成本。
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