在分娩前查细菌性阴道病:一个成本效益研究
Hope E Knochenhauer1, Stephanie L Lim2, Laura J Havrilesky2
1Department of Obstetrics and Gynecolgy, Staten Island University, Northwell Health, Staten Island, New York.
American journal of perinatology
|April 30, 2024
概括
在怀孕期间治疗细菌性阴道炎 (BV),特别是在剖腹产期间用静脉注射的美特罗尼达,是降低产后手术部位感染 (SSI) 的成本有效策略. 常规查和治疗BV提供了好处,同时保持了抗生素管理.
科学领域:
- 产科和妇科 产科和妇科
- 传染性疾病 传染性疾病
- 卫生经济学 卫生经济学
背景情况:
- 细菌性阴道炎 (BV) 是孕妇常见的阴道疾病.
- 在剖腹产后,BV殖民可能与产后手术部位感染 (SSI) 的风险增加有关.
- 当前的护理标准往往不包括在怀孕期间对BV进行测试或治疗.
研究的目的:
- 为了比较三个策略的成本效益,在怀孕期间查和/或治疗细菌性阴道炎 (BV).
- 评估包括不治疗,怀孕36周的测试和治疗以及剖腹产时的经验治疗在内的策略.
- 确定预防产后SSI的最有效和最经济的方法.
主要方法:
- 从第三方付款人的角度开发了一个决策分析成本效益模型.
- 临床和成本数据来源于文献,手术质量数据库,生命统计和药物成本.
- 成本估计被调整为2020美元,有效性被定义为SSI避免.
主要成果:
- "没有治疗"策略 (当前标准) 是最昂贵的 (59.16美元) 和最不有效的 (3.71%的SSI率).
- 经验性地治疗所有剖腹产患者 ("治疗所有剖腹产") 是最有效的 (2.75%的SSI率) 和最便宜的 (53.50美元).
- 检测和治疗阳性病例 ("测试治疗") 也是有效的 (2.94%的SSI率) 和相对便宜的 (57.05美元).
结论:
- 在剖腹产期间用静脉注射的美트로尼达治疗孕妇是预防SSI的潜在有效和节省成本的策略.
- 查和治疗BV ("试验治疗") 是一个合理的替代方案,提供抗生素管理的好处.
- 在所有分析中,在分娩前不治疗BV的标准方法被发现是次优的.
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