Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis.
Summary of "Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis."
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;
DOI:
10.1111/j.1471-0528.2011.03249.x. 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.
Affiliation
Department of Obstetrics and Gynecology, University of Michigan Health System Department of Obstetrics and Gynecology, St Joseph Mercy Health System, Ann Arbor, MI, USA.
Journal Details
This article was published in the following journal.
Name: BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22251453
- DOI: http://dx.doi.org/10.1111/j.1471-0528.2011.03249.x
Medical and Biotech [MESH] Definitions
Impetigo
A common superficial bacterial infection caused by STAPHYLOCOCCUS AUREUS or group A beta-hemolytic streptococci. Characteristics include pustular lesions that rupture and discharge a thin, amber-colored fluid that dries and forms a crust. This condition is commonly located on the face, especially about the mouth and nose.
Viridans Streptococci
A large heterogeneous group of mostly alpha-hemolytic streptococci. They colonize the respiratory tract at birth and generally have a low degree of pathogenicity. This group of species includes STREPTOCOCCUS MITIS; STREPTOCOCCUS MUTANS; STREPTOCOCCUS ORALIS; STREPTOCOCCUS SANGUIS; STREPTOCOCCUS SOBRINUS; and the STREPTOCOCCUS MILLERI GROUP. The latter are often beta-hemolytic and commonly produce invasive pyogenic infections including brain and abdominal abscesses.
Nurseries, Hospital
Hospital facilities which provide care for newborn infants.
Early Intervention (education)
Procedures and programs that facilitate the development or skill acquisition in infants and young children who have disabilities, who are at risk for developing disabilities, or who are gifted. It includes programs that are designed to prevent handicapping conditions in infants and young children and family-centered programs designed to affect the functioning of infants and children with special needs. (From Journal of Early Intervention, Editorial, 1989, vol. 13, no. 1, p. 3; A Discursive Dictionary of Health Care, prepared for the U.S. House of Representatives Committee on Interstate and Foreign Commerce, 1976)
Streptococcus Equi
A species of gram-positive, coccoid bacteria isolated from abscesses in submaxillary glands and mucopurulent discharges of the upper respiratory tract of horses. This organism belongs to Group C streptococci with regards to antigen response and is known to cause strangles. The subspecies S. zooepidemicus is also considered a pathogen of horses.
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