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Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis

Albright, Catherine M. MD; MacGregor, Caitlin MD; Sutton, Desmond MD; Theva, Meena MD; Hughes, Brenna L. MD; Werner, Erika F. MD

doi: 10.1097/AOG.0000000000001800
Contents: Original Research

OBJECTIVE: To estimate the cost-effectiveness of universal group B streptococci (GBS) screening in women with a singleton pregnancy planning a repeat cesarean delivery.

METHODS: We conducted a decision analysis from a health care perspective to compare the cost-effectiveness of GBS screening for women planning a repeat cesarean delivery. With universal screening, all GBS-positive women who labored before a scheduled cesarean delivery received antibiotic prophylaxis. With no screening, women who presented in labor received antibiotics based on risk-based criteria. Neonates born to women colonized with GBS were at risk for early-onset GBS disease, disability, and death. We assumed a GBS prevalence of 25%, that 26.6% of women labored between 35 weeks of gestation and their scheduled time for cesarean delivery, and that 3.3% who planned a repeat cesarean delivery instead delivered vaginally. The primary outcome was cost per neonatal quality-adjusted life-year gained, with a cost-effectiveness threshold of $100,000 per quality-adjusted life-year. Neonatal quality of life was assessed using five health states (healthy, mild, moderate, or severe disability, and death) with a life expectancy of 79 years for healthy neonates. One-way sensitivity and Monte Carlo analyses were used to evaluate the results.

RESULTS: In the base case, universal GBS screening in women planning a repeat cesarean delivery was not cost-effective compared with no screening, costing $114,445 per neonatal quality-adjusted life-year gained. The cost to prevent an adverse outcome from GBS exceeded $400,000. If greater than 28% of women were GBS-positive, greater than 29% labored before their scheduled delivery, or greater than 10% delivered vaginally, universal screening became cost effective.

CONCLUSION: Universal GBS screening in women with a singleton pregnancy planning a repeat cesarean delivery may not be cost-effective in all populations. However, in populations with a high GBS prevalence, women at high risk of laboring before their scheduled cesarean delivery, or women who may ultimately opt for a vaginal delivery, GBS screening may be cost effective.

Universal group B streptococci screening in women with a singleton pregnancy intending to have a repeat cesarean delivery may not be cost-effective in all populations.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.

Corresponding author: Catherine M. Albright, MD, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195-6460; email: cmalbrig@uw.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the 2016 Society for Maternal-Fetal Medicine Annual Meeting, February 1–6, 2016, Atlanta, Georgia.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.