(264) Administering antibiotics to women with isolated maternal fever during labor : A decision-tree model

A decision-tree model using the Expected Utility Theory (EUT) was employed to compare two strategies for managing isolated fever in women during labor:

1.         Antibiotic Treatment: Administration of antibiotics.

2.         No Treatment: Observation without antibiotics.

The Expected Utility Theory by Von Neumann and Morgenstern was used for theory of decision making under uncertainty (when the probabilities of the outcomes are known).

The assumptions used in the decision model, including the costs, probabilities, and utilities of various outcomes associated with the management of isolated maternal fever during labor were based on a study by Bank et al. (Bank TC et l.  Am J Obstet Gynecol. 2022 Feb;226(2):255.e1-255.e7. (Table 1).

A one-way sensitivity analysis was conducted to explore the impact of variations in key variables. Outcome measures included expected utility (equivalent to QALYs) and cost effectiveness analysis.

Results:

1. The expected utility of the no-antibiotic strategy is 0.854, which is greater than the expected utility of the antibiotic strategy (0.797).


2. Among all the assumptions made in the model, the utility value assigned to the Neonatal Intensive Care Unit (NICU) has the most significant impact on the overall expected utility of the decision strategies (Figure 1).


3. The cost-effectiveness analysis shows that the no-antibiotic strategy is less costly and has better clinical outcomes.