Akker-van Marle M E, Rijnders M E B, Dommelen P, Fekkes M, Wouwe J P, Amelink-Verburg M P, Verkerk P H
TNO Prevention and Health, Department of Social Pediatrics and Child and Youth Health Care, Leiden, The Netherlands.
BJOG. 2005 Jun;112(6):820-6. doi: 10.1111/j.1471-0528.2005.00555.x.
To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk-based strategy, a screening-based strategy, a combined screening/risk-based strategy and the current Dutch guideline.
Cost-effectiveness analysis based on decision model.
Obstetric care system in the Netherlands.
POPULATION/SAMPLE: Hypothetical cohort of 200,000 neonates.
A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%. Main outcome measures Cost per quality adjusted of life-year (QALY).
The risk-based strategy will prevent 352 cases of early-onset GBS for 5.0 million Euros, indicating a cost-effectiveness ratio of 7600 Euros per QALY gained. The combined screening risk-based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening-based strategy shows the highest reduction in cases of early-onset GBS, however, at a cost-effectiveness ratio of 59,300 Euros per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost-effectiveness ratio.
In the Dutch system, the combined screening/risk-based strategy and the risk-based strategy have reasonable cost-effectiveness ratios. If it becomes feasible to add the PCR test, the cost-effectiveness of the combined screening/risk-based strategy may even be more favourable.
评估荷兰采用产时抗生素预防措施预防早发型B族链球菌（GBS）疾病的不同治疗策略的成本和效果。治疗策略包括基于风险的策略、基于筛查的策略、筛查/风险联合策略以及荷兰现行指南。
基于决策模型的成本效益分析。
荷兰的产科护理系统。
研究对象/样本：200,000名新生儿的假设队列。
使用决策分析模型比较不同治疗策略与不治疗的成本和效果。基线估计值来自文献以及对GBS疾病患儿父母的一项调查。分析从社会角度进行，成本和效果按3%的比例进行贴现。主要结局指标为每质量调整生命年（QALY）的成本。
基于风险的策略花费500万欧元可预防352例早发型GBS，表明每获得一个QALY的成本效益比为7600欧元。筛查/风险联合策略有类似结果。荷兰现行指南成本更高但效果更低。基于筛查的策略显示早发型GBS病例减少最多，然而，每获得一个QALY的成本效益比为59,300欧元。引入聚合酶链反应（PCR）检测可能会带来更有利的成本效益比。
在荷兰系统中，筛查/风险联合策略和基于风险的策略有合理的成本效益比。如果增加PCR检测变得可行，筛查/风险联合策略的成本效益可能会更有利。
