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

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Albright, CM; MacGregor, C; Sutton, D; Theva, M; Hughes, BL; Werner, EF
Published in: Obstet Gynecol
January 2017

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.

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Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

January 2017

Volume

129

Issue

1

Start / End Page

111 / 119

Location

United States

Related Subject Headings

  • Vagina
  • Streptococcus agalactiae
  • Streptococcal Infections
  • Rectum
  • Quality-Adjusted Life Years
  • Quality of Life
  • Preoperative Care
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Mass Screening
 

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Albright, C. M., MacGregor, C., Sutton, D., Theva, M., Hughes, B. L., & Werner, E. F. (2017). Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis. In Obstet Gynecol (Vol. 129, pp. 111–119). United States. https://doi.org/10.1097/AOG.0000000000001800
Albright, Catherine M., Caitlin MacGregor, Desmond Sutton, Meena Theva, Brenna L. Hughes, and Erika F. Werner. “Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis.” In Obstet Gynecol, 129:111–19, 2017. https://doi.org/10.1097/AOG.0000000000001800.
Albright CM, MacGregor C, Sutton D, Theva M, Hughes BL, Werner EF. Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis. In: Obstet Gynecol. 2017. p. 111–9.
Albright, Catherine M., et al. “Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis.Obstet Gynecol, vol. 129, no. 1, 2017, pp. 111–19. Pubmed, doi:10.1097/AOG.0000000000001800.
Albright CM, MacGregor C, Sutton D, Theva M, Hughes BL, Werner EF. Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis. Obstet Gynecol. 2017. p. 111–119.

Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

January 2017

Volume

129

Issue

1

Start / End Page

111 / 119

Location

United States

Related Subject Headings

  • Vagina
  • Streptococcus agalactiae
  • Streptococcal Infections
  • Rectum
  • Quality-Adjusted Life Years
  • Quality of Life
  • Preoperative Care
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Mass Screening