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Updated: Jul 23, 2025
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Cost-effectiveness analysis of maternal vaccination against Group B streptococcus in Japan
Sumire Sorano1,2, Simon R Procter3, Anna C Seale3,4
1Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.
Insights
A maternal Group B Streptococcus (GBS) vaccine in Japan could prevent infant GBS disease, deaths, and stillbirths. This vaccine is likely cost-effective, offering significant health benefits beyond current screening methods.
Area of Science:
- Perinatal Health
- Infectious Disease Prevention
- Health Economics
Background:
- Group B Streptococcus (GBS) is a major cause of neonatal infections, preterm birth, and stillbirth.
- Current Japanese guidelines for GBS involve prenatal screening and intrapartum antimicrobial prophylaxis (IAP), which do not prevent all GBS-related adverse outcomes.
- Maternal GBS vaccines under development aim to prevent infant GBS disease and may offer broader perinatal benefits.
Purpose of the Study:
- To assess the cost-effectiveness of a future maternal GBS vaccine in Japan.
- To compare a strategy of maternal GBS vaccination plus screening/IAP against screening/IAP alone.
- To evaluate the economic impact of a GBS vaccine that also prevents preterm birth.
Main Methods:
- A decision tree model was utilized to estimate GBS disease cases, mortality, neuro-developmental impairment, stillbirths, costs, and Quality-Adjusted Life Years (QALYs).
- The study calculated the threshold vaccine price for cost-effectiveness at ¥5 million/QALY.
- Scenario analysis explored the impact of a vaccine preventing preterm birth.
Main Results:
- Maternal GBS vaccination could prevent an additional 142 infant GBS cases, 5 deaths, 21 NDI cases, and 13 stillbirths annually in Japan.
- The incremental cost-effectiveness ratio (ICER) was ¥3.78 million/QALY at a vaccine price of ¥5,000/dose.
- Including QALYs lost for stillbirths reduced the ICER to ¥1.78 million/QALY; a vaccine preventing preterm birth yielded an ICER of ¥1.88 million/QALY.
Conclusions:
- A maternal GBS vaccine is likely cost-effective in Japan at ¥5,000/dose, significantly improving perinatal outcomes.
- Vaccine effectiveness against additional adverse perinatal outcomes, such as preterm birth, enhances health benefits and cost-effectiveness.
- The findings support the potential value of maternal GBS vaccination in reducing disease burden and improving infant and maternal health.
Background:
Group B Streptococcus (GBS) is a leading pathogen causing life-threatening bacterial infections in neonates (early- or late-onset) and infants, and is associated with preterm and stillbirth. Japan introduced national guidelines to reduce early-onset neonatal GBS disease, with universal prenatal screening and intrapartum antimicrobial prophylaxis (IAP). However, screening/IAP does not prevent GBS associated late-onset disease, preterm or stillbirth. Maternal GBS vaccines in development are targeted at infant GBS disease but may provide benefit across perinatal outcomes. We aimed to assess cost-effectiveness of a future maternal GBS vaccine, for a base case prevention of infant GBS disease in combination with screening/IAP compared to screening/IAP alone.
Methods:
We used a decision tree model to estimate cases of infant GBS disease, deaths, and neuro-developmental impairment (NDI), GBS-related stillbirths, and the associated costs and loss in Quality-Adjusted Life Years (QALYs). We calculate the threshold price at which a vaccine would be cost-effective assuming a cost-effectiveness threshold of ¥5 million/QALY. We explored the potential benefit of a maternal GBS vaccine that also prevents preterm birth in a scenario analysis.
Results:
Maternal GBS vaccination in Japan could prevent an additional 142 infant GBS cases annually, including 5 deaths and 21 cases of NDI, and 13 stillbirths compared to screening/IAP alone. The incremental cost-effectiveness ratio (ICER) was ¥3.78 million/QALY with a vaccine cost of ¥5,000/dose. If the QALY lost for stillbirth is included, the ICER is reduced to ¥1.78 million/QALY. Median threshold vaccine price was ¥6,900 per dose (95 % uncertainty interval ¥5,100 to ¥9,200 per dose). If maternal GBS vaccination also prevented half of GBS-associated preterm, the ICER would be reduced to ¥1.88 million/QALY.
Conclusions:
An effective maternal GBS vaccine is likely to be considered cost-effective in Japan at a price of ¥5,000/dose. Effectiveness against other adverse perinatal outcomes would increase health benefits and cost-effectiveness.
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