Mohle-Boetani J C, Schuchat A, Plikaytis B D, Smith J D, Broome C V
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333.
JAMA. 1993;270(12):1442-8.
Intrapartum antibiotics can prevent early-onset neonatal group B streptococcal (GBS) disease but have not been widely used. Obstacles include difficulty in implementing screening for GBS colonization and uncertainty about cost-effectiveness. The GBS vaccines for disease prevention are now being developed.
We developed a decision analysis model and used standard cost-effectiveness and cost-benefit analysis methods. We compared the outcomes and costs of the recent practice of no intervention with those expected for three prevention strategies: (1) intrapartum antibiotics administered to colonized women with labor complications, (2) an alternative strategy that does not require screening but uses epidemiologic criteria and labor complications to target intrapartum antibiotics, and (3) maternal vaccination. We used data from multistate population-based surveillance to estimate the potential impact of each strategy on disease and costs in the United States.
Intrapartum antibiotic prophylaxis of high-risk women identified by screening could prevent approximately 3300 cases (47% of neonatal disease) annually in the United States and could save approximately $16 million in direct medical costs. Chemoprophylaxis of high-risk women identified using epidemiologic criteria could potentially be equally effective (3200 cases prevented) and would avoid the logistical difficulties of screening; the net savings would be approximately $66 million. Vaccinating 80% of pregnant women with a vaccine that prevents 80% of cases among infants born at or after 34 weeks of gestation would prevent approximately 4100 neonatal cases annually with a net savings of $131 million.
Universal prenatal screening for GBS and chemoprophylaxis of colonized women with labor complications is likely to be cost-beneficial in the United States. Development of alternative strategies should be further explored for populations in which GBS screening is impractical. Continued development of a GBS vaccine is an important public health priority.
产时使用抗生素可预防早发型新生儿B族链球菌（GBS）疾病，但尚未得到广泛应用。障碍包括实施GBS定植筛查存在困难以及成本效益存在不确定性。目前正在研发用于疾病预防的GBS疫苗。
我们构建了一个决策分析模型，并使用标准的成本效益和成本效益分析方法。我们将近期不进行干预的做法的结果和成本与三种预防策略预期的结果和成本进行了比较：（1）对有分娩并发症的定植女性给予产时抗生素；（2）一种无需筛查但使用流行病学标准和分娩并发症来确定产时抗生素使用对象的替代策略；（3）母体接种疫苗。我们使用基于多州人群监测的数据来估计每种策略对美国疾病和成本的潜在影响。
对通过筛查确定的高危女性进行产时抗生素预防，在美国每年可预防约3300例病例（占新生儿疾病的47%），并可节省约1600万美元的直接医疗成本。使用流行病学标准确定高危女性进行化学预防可能同样有效（预防3200例病例），并可避免筛查的后勤困难；净节省约6600万美元。对80%的孕妇接种一种能预防34周及以后出生婴儿中80%病例的疫苗，每年可预防约4100例新生儿病例，净节省1.31亿美元。
在美国，对GBS进行普遍产前筛查并对有分娩并发症的定植女性进行化学预防可能具有成本效益。对于GBS筛查不切实际的人群，应进一步探索替代策略的开发。继续研发GBS疫苗是一项重要的公共卫生优先事项。
