scholarly journals Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization

2009 ◽  
Vol 2009 ◽  
pp. 1-11 ◽  
Author(s):  
Mark A. Turrentine ◽  
Mildred M. Ramirez ◽  
Joan M. Mastrobattista
Keyword(s):  
Early Onset ◽  
Positive Culture ◽  
Cost Effective ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Group B Streptococci ◽  
Neonatal Deaths ◽  
History Of ◽  
Group B ◽  
Universal Treatment

Objective. To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy.Study Design. A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis.Results. When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8 805 versus $12 710).Conclusion. Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

scholarly journals Antibiotic Susceptibility of Invasive Group B Streptococci from Neonates with Early-Onset Disease - A Multi Center Study 1995-97

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 208A-208A ◽  
Author(s):  
F Y Lin ◽  
L E Weisman ◽  
P H Azimi ◽  
J A Regan ◽  
Joseph B Philips ◽  
...  
Keyword(s):  
Early Onset ◽  
Antibiotic Susceptibility ◽  
Group B Streptococci ◽  
Invasive Group ◽  
Group B ◽  
Multi Center Study ◽  
Center Study

Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits

2003 ◽  
Vol 10 (3) ◽  
pp. 546-556 ◽  
Author(s):  
David A. Axelrod ◽  
A. Mark Fendrick ◽  
Ruth C. Carlos ◽  
Robert J. Lederman ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Analysis ◽  
Renal Artery ◽  
Incremental Cost ◽  
Renal Artery Stenosis ◽  
Cost Effective ◽  
Artery Stenosis ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Refractory Hypertension

Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.

scholarly journals Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Margrét Johansson Gudjónsdóttir ◽  
Anders Elfvin ◽  
Elisabet Hentz ◽  
Ingegerd Adlerberth ◽  
Ingemar Tessin ◽  
...  
Keyword(s):  
Early Onset ◽  
Antimicrobial Prophylaxis ◽  
List Type ◽  
Neonatal Infections ◽  
Group B Streptococci ◽  
Gram Negative ◽  
Live Births ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Group B

Abstract Background The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975. Methods Observational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975. Results The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge. Conclusion There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area. Key notes This study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections.The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports.No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life.

scholarly journals Neonatal and young infant sepsis by Group B Streptococci and Escherichia coli: a single-center retrospective analysis in Germany—GBS screening implementation gaps and reduction in antibiotic resistance

2020 ◽  
Vol 179 (11) ◽  
pp. 1769-1777
Author(s):  
Maren Doenhardt ◽  
Barbara Seipolt ◽  
Lars Mense ◽  
Jennifer Lucia Winkler ◽  
Alexander Thürmer ◽  
...  
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Young Infant ◽  
Antibiotic Use ◽  
Group B Streptococci ◽  
E Coli ◽  
Antimicrobial Substances ◽  
Intrapartum Antibiotic ◽  
Group B ◽  
Implementation Gaps

Abstract The last nationwide surveillance study on neonatal and young infant sepsis due to Group B Streptococci (GBS) and Escherichia coli in Germany was conducted between 2009 and 2010. The aim of this study is to provide longitudinal epidemiological data on neonatal and young infant sepsis caused by GBS and E. coli to reevaluate existing data and to inform clinical decision-making. Every positive blood culture for GBS and E. coli within the first 90 days of life that occurred at our center from 2008 until 2018 was identified. The epidemiological, clinical, laboratory, and microbiological data of all affected patients were analyzed through retrospective chart review, along with the pathogen’s antimicrobial susceptibility results. In total, 106 episodes of neonatal sepsis were described; 31% (n = 33) being caused by GBS and 69% (n = 73) by E. coli; 87% of GBS early-onset disease (EOD) cases did not receive intrapartum antibiotic prophylaxis (IAP). Contrary to general trends, the proportion of resistant E. coli isolates decreased for all tested antibiotics over time. Coincidentally, antenatal antibiotic use beyond IAP during that period decreased significantly in our center. Conclusions: (1) Data at our center suggests at least a regional implementation gap in GBS screening and IAP. (2) The decline in the resistance rate of E. coli for all antimicrobial substances might indicate that the reduction of prenatal antibiotics use is beneficial and that neonatal antibiotic stewardship programs should include pregnant women as well. What is Known:• GBS screening and intrapartum antibiotic prophylaxis led to a 32%-reduction in GBS disease in Germany with a 0.75 (92:122) ratio of early-onset disease to late-onset disease in 2009–2010.• Prenatal antibiotic use might increase the risk of E. coli early-onset disease and antibiotic resistances. What is New:• The GBS early-onset disease rates were twice as high as those of late-onset disease, the ratio was 1.75 (21:12) in 2008–2018 at our institution. This suggests that there are at least regional implementation gaps in the antenatal GBS screening in Germany.• We found a decline in E. coli resistance rates over time for all antimicrobial substances. Reduction in use of prenatal antibiotics might be an explanation.

Meta-analysis and cost-effectiveness of second-line antiepileptic drugs for status epilepticus

Neurology ◽  
2019 ◽  
Vol 92 (20) ◽  
pp. e2339-e2348 ◽  
Author(s):  
Iván Sánchez Fernández ◽  
Marina Gaínza-Lein ◽  
Nathan Lamb ◽  
Tobias Loddenkemper
Keyword(s):  
Status Epilepticus ◽  
Cost Effectiveness ◽  
Antiepileptic Drugs ◽  
Meta Analysis ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Convulsive Status Epilepticus ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
The Cost

ObjectiveCompare the cost and effectiveness of nonbenzodiazepine antiepileptic drugs (non-BZD AEDs) for treatment of BZD-resistant convulsive status epilepticus (SE).MethodsDecision analysis model populated with effectiveness data from a systematic review and meta-analysis of the literature, and cost data from publicly available prices. The primary outcome was cost per seizure stopped ($/SS). Sensitivity analyses evaluated the robustness of the results across a wide variation of the input parameters.ResultsWe included 24 studies with 1,185 SE episodes. The most effective non-BZD AED was phenobarbital (PB) with a probability of SS of 0.8 (95% confidence interval [CI]: 0.69–0.88), followed by valproate (VPA) (0.71 [95% CI: 0.61–0.79]), lacosamide (0.66 [95% CI: 0.51–0.79]), levetiracetam (LEV) (0.62 [95% CI: 0.5–0.73]), and phenytoin/fosphenytoin (PHT) (0.53 [95% CI: 0.39–0.67]). In pairwise comparisons, PB was more effective than PHT (p = 0.002), VPA was more effective than PHT (p = 0.043), and PB was more effective than LEV (p = 0.018). The most cost-effective non-BZD AED was LEV (incremental cost-effectiveness ratio [ICER]: $18.55/SS), followed by VPA (ICER: $94.44/SS), and lastly PB (ICER: $847.22/SS). PHT and lacosamide were not cost-effective compared to the other options. Sensitivity analyses showed marked overlap in cost-effectiveness, but PHT was consistently less cost-effective than LEV, VPA, and PB.ConclusionVPA and PB were more effective than PHT for SE. There is substantial overlap in the cost-effectiveness of non-BZD AEDs for SE, but available evidence does not support the preeminence of PHT, neither in terms of effectiveness nor in terms of cost-effectiveness.

scholarly journals Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Kam Lun Hon ◽  
King Hang Chan ◽  
Pak Long Ko ◽  
King Woon So ◽  
Alexander K. C. Leung
Keyword(s):  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Cost Effective ◽  
Rapid Onset ◽  
Current Treatment ◽  
Effective Solution ◽  
Birth Canal ◽  
Group B

We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.

Management of intracranial aneurysms

2015 ◽  
Author(s):  
Yves Pirson ◽  
Dominique Chauveau
Keyword(s):  
Autosomal Dominant ◽  
Three Dimensional ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Patient Anxiety ◽  
Polycystic Kidney ◽  
Adequate Information ◽  
Treatment Of Hypertension ◽  
History Of ◽  
Autosomal Dominant Polycystic Kidney

An asymptomatic intracranial aneurysm (ICA) is found by screening in about 8% of patients with autosomal dominant polycystic kidney disease (ADPKD), with a trend to cluster in some families. Though most ICAs will remain asymptomatic, a minority of them may rupture, causing subarachnoid haemorrhage (SAH). Given the grave prognosis of ICA rupture, screening and prophylactic repair of unruptured ICAs have to be considered, with the aim to identify patients with a risk of ICA rupture that exceeds the risk of a prophylactic procedure, surgical or endovascular. Relying on a decision analysis model established in the general population, widespread screening in ADPKD patients is today not recommended. However, the chapter authors advise screening in ADPKD patients with a familial history of ICA or SAH. Additional acceptable indications are high-risk occupations and patient anxiety despite adequate information. Screening is preferably performed by high-resolution, three-dimensional, time-of-flight magnetic resonance imaging. When an asymptomatic ICA is found, a recommendation for whether to intervene depends on its size, site, morphology, patient life expectancy, and general health as well as the experience of the neuroradiologist–neurosurgeon team. Since the risk of new ICAs or enlargement of an existing one is very low in those with small (< 6 mm) ICAs, conservative management is usually recommended. Elimination of tobacco use and aggressive treatment of hypertension are strongly recommended.

Group B Streptococcus

1986 ◽  
Vol 7 (S2) ◽  
pp. 135-137 ◽  
Author(s):  
Charles S.F. Easmon
Keyword(s):  
United States ◽  
Early Onset ◽  
Western Europe ◽  
Late Onset ◽  
Group B Streptococcus ◽  
The United States ◽  
Group B Streptococci ◽  
Neonatal Group ◽  
Group B ◽  
Portal Of Entry

Over the past 25 years group B streptococci have become established as one of the main bacterial pathogens of the neonate in Western Europe and the United States. The attack rate of 0.25/1,000 live births found by Mayon White in Great Britain1 appears typical of many European countries. However, in some centers in the United States attack rates can be over 10 times higher.Two types of neonatal group B streptococcus (GBS) diseases exist, “early” and “late” onset. Early onset disease usually presents within the first few days of life. Often the most serious infections are present at birth or seen within a few hours. Early onset disease presents with pneumonia, respiratory distress and shock. Bacteremia is normally present and meningitis may occur. Mortality is high (50% to 75%). The portal of entry is probably the respiratory tract. Infants normally acquire the infecting organism from their mothers. Heavy maternal and infant colonization, prolonged rupture of membranes, prematurity, and obstetric complications are all risk factors.Delayed onset disease, as its name suggests, presents after the first week of life, primarily with bacteremia and meningitis. Mortality is much lower than for the early onset form, but still appreciable for a bacterial infection (14% to 18%). Its epidemiology is uncertain.

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