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A Murine Model of Group B Streptococcus Vaginal Colonization
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Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis.

Catherine M Albright1, Caitlin MacGregor, Desmond Sutton

  • 1Division 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.

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Universal group B streptococci (GBS) screening for pregnant women planning repeat cesarean delivery is not cost-effective in all cases. Screening may be beneficial in populations with high GBS prevalence or risk factors for early delivery.

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Health
  • Health Economics

Background:

  • Group B streptococci (GBS) colonization poses a risk for neonatal early-onset disease, disability, and death.
  • Women planning repeat cesarean deliveries may still experience labor before their scheduled procedure.
  • Current GBS screening strategies may not be universally cost-effective for this specific obstetric population.

Purpose of the Study:

  • To evaluate the cost-effectiveness of universal GBS screening in pregnant women undergoing repeat cesarean delivery.
  • To compare universal screening versus risk-based criteria for antibiotic prophylaxis in this population.
  • To determine the impact of GBS prevalence and delivery circumstances on screening cost-effectiveness.

Main Methods:

  • Decision analysis model from a healthcare perspective.
  • Comparison of universal GBS screening versus no screening with risk-based criteria.
  • Inclusion of GBS prevalence, labor onset before scheduled delivery, and unplanned vaginal delivery rates.
  • Primary outcome: cost per neonatal quality-adjusted life-year (QALY) gained, using a $100,000/QALY threshold.
  • Sensitivity and Monte Carlo analyses to assess result robustness.

Main Results:

  • Universal GBS screening was not cost-effective in the base case, costing $114,445 per QALY gained.
  • The cost to prevent an adverse GBS outcome exceeded $400,000.
  • Screening became cost-effective if GBS prevalence exceeded 28%, labor onset before delivery was >29%, or unplanned vaginal delivery was >10%.

Conclusions:

  • Universal GBS screening in women planning repeat cesarean deliveries is not universally cost-effective.
  • Screening may be cost-effective in specific populations with high GBS prevalence or increased risk of labor/vaginal delivery.
  • Tailoring screening strategies to population-specific risk factors is recommended.