Centre for Guidelines, National Institute for Health and Care Excellence (NICE), London, UK.
Group B Strep Support, Haywards Heath, West Sussex, UK.
BJOG. 2022 Sep;129(10):1779-1789. doi: 10.1111/1471-0528.17119. Epub 2022 Mar 8.
What are the costs, benefits and harms of immediate birth compared with expectant management in women with prolonged preterm prelabour rupture of membranes (PPROM) at 34 -36 weeks of gestation and detection of vaginal or urine group B streptococcus (GBS)?
Mathematical decision model comprising three independent decision trees.
UK National Health Service (NHS) and personal social services perspective.
Women testing positive for GBS with PPROM at 34 -36 weeks of gestation.
The model estimates lifetime costs and quality-adjusted life years (QALYs) using evidence from randomised trials, UK NHS data sources and further observational studies. Simulated events include neonatal infections, morbidity associated with preterm birth and consequences of caesarean birth. Deterministic and probabilistic sensitivity analyses (PSAs) were performed.
QALYs, costs and incremental cost-effectiveness ratio (ICER).
In this population, immediate birth dominates expectant management: it is more effective (average lifetime QALYs, 24.705 versus 24.371) and it is cheaper (average lifetime costs, £14,372 versus £19,311). In one-way sensitivity analysis, results are robust to all but the odds ratio estimating the relative effect on incidence of infections. Threshold analysis shows that the odds of infection only need to be >1.5% with expectant management for the benefit of avoiding infections to outweigh the disadvantages of immediate birth. In PSA, immediate birth is the preferred option in >80% of simulations.
Neonatal GBS infections are expensive to treat and may result in substantial adverse health consequences. Therefore, immediate birth, which is associated with a reduced risk of neonatal infection compared with expectant management, is expected to generate better health outcomes and decreased lifetime costs.
For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management.
在妊娠 34-36 周时胎膜早破且阴道或尿液中检出 B 族链球菌（GBS）的孕妇中，与期待管理相比，即刻分娩的成本、获益和危害如何？
包含三个独立决策树的数学决策模型。
英国国民保健制度（NHS）和个人社会服务视角。
妊娠 34-36 周时胎膜早破且 GBS 检测阳性的孕妇。
该模型使用随机试验、英国 NHS 数据来源和进一步的观察性研究中的证据来估计终生成本和质量调整生命年（QALY）。模拟事件包括新生儿感染、早产相关发病率和剖宫产的后果。进行了确定性和概率敏感性分析（PSA）。
QALY、成本和增量成本效益比（ICER）。
在该人群中，即刻分娩优于期待管理：它更有效（平均终生 QALY，24.705 比 24.371），且更便宜（平均终生成本，£14372 比 £19311）。在单向敏感性分析中，结果对除了估计感染发生率的相对效果的比值比之外的所有因素均具有稳健性。阈值分析表明，仅当期待管理下感染的可能性比即时分娩高出 1.5%时，避免感染的益处才会超过即时分娩的不利影响。在 PSA 中，80%以上的模拟结果都倾向于即刻分娩。
新生儿 GBS 感染的治疗费用昂贵，可能导致严重的健康后果。因此，与期待管理相比，与新生儿感染风险降低相关的即刻分娩有望产生更好的健康结果并降低终生成本。
对于有早产胎膜早破和阴道或尿液样本中 B 族链球菌的孕妇，与期待管理相比，即刻分娩可改善婴儿的健康状况并降低成本。
