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A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease
Diny G E Kolkman1, Marlies E B Rijnders, Maurice G A J Wouters
1Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands. diny.kolkman@tno.nl.
Insights
This study evaluates Group B Streptococcus prevention strategies in the Netherlands, finding that risk-based and combination approaches are most cost-effective in practice. Recommendations will guide implementation for reducing neonatal infections.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Public Health
Background:
- Early-onset Group B Streptococcus (GBS) infection is a significant cause of neonatal morbidity and mortality.
- Intrapartum antibiotic prophylaxis (IAP) is key for primary prevention of EOGBS.
- Previous studies suggest risk-based or combination strategies are most cost-effective, assuming 100% adherence.
Purpose of the Study:
- To implement and evaluate the effectiveness of the current Dutch guideline, a risk-based strategy, and a combination strategy for EOGBS prevention in pilot regions.
- To assess adherence, clinical outcomes, and costs associated with different EOGBS prevention strategies in daily practice.
Main Methods:
- A randomized trial in three pilot regions comparing the current guideline, risk-based, and combination strategies.
- Pre- and post-intervention testing involving 105 pregnant women (pre-test) and 315 women (post-test) per region.
- Outcome measures include adherence, maternal and neonatal outcomes, and cost-effectiveness.
Main Results:
- The study aims to determine the adherence rates and influencing factors for each strategy.
- It will evaluate the impact of each strategy on maternal and neonatal health outcomes.
- Cost-effectiveness will be analyzed in relation to observed effects and adherence.
Conclusions:
- This research will provide evidence-based recommendations for the optimal implementation of EOGBS prevention in the Netherlands.
- Findings will focus on the most cost-effective strategy considering real-world adherence and feasibility.
Background:
Early-onset Group B haemolytic streptococcus infection (EOGBS) is an important cause of neonatal morbidity and mortality in the first week of life. Primary prevention of EOGBS is possible with intra-partum antibiotic prophylaxis (IAP.) Different prevention strategies are used internationally based on identifying pregnant women at risk, either by screening for GBS colonisation and/or by identifying risk factors for EOGBS in pregnancy or labour. A theoretical cost-effectiveness study has shown that a strategy with IAP based on five risk factors (risk-based strategy) or based on a positive screening test in combination with one or more risk factors (combination strategy) was the most cost-effective approach in the Netherlands. IAP for all pregnant women with a positive culture in pregnancy (screening strategy) and treatment in line with the current Dutch guideline (IAP after establishing a positive culture in case of pre-labour rupture of membranes or preterm birth and immediate IAP in case of intra-partum fever, previous sibling with EOGBS or GBS bacteriuria), were not cost-effective. Cost-effectiveness was based on the assumption of 100% adherence to each strategy. However, adherence in daily practice will be lower and therefore have an effect on cost-effectiveness.
Method/Design:
The aims are to: a.) implement the current Dutch guideline, the risk-based strategy and the combination strategy in three pilot regions and b.) study the effects of these strategies in daily practice. Regions where all the care providers in maternity care implement the allocated strategy will be randomised. Before the introduction of the strategy, there will be a pre-test (use of the current guideline) involving 105 pregnant women per region. This will be followed by a post-test (use of the allocated strategy) involving 315 women per region. The outcome measures are: 1.) adherence to the specific prevention strategy and the determinants of adherence among care providers and pregnant women, 2.) outcomes in pregnant women and their babies and 3.) the costs of each strategy in relation to the effects.
Discussion:
This study will provide recommendations for the implementation of the most cost-effective prevention strategy for EOGBS in the Netherlands on the basis of feasibility in daily practice.
Trial Registration:
Dutch Trial Register, NTR3965.
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