Comparison of prevention strategies for neonatal group B streptococcal infection. A population-based economic analysis.
BACKGROUND
Intrapartum antibiotics can prevent early-onset neonatal group B streptococcal (GBS) disease but have not been widely used. Obstacles include difficulty in implementing screening for GBS colonization and uncertainty about cost-effectiveness. The GBS vaccines for disease prevention are now being developed.


METHODS
We developed a decision analysis model and used standard cost-effectiveness and cost-benefit analysis methods. We compared the outcomes and costs of the recent practice of no intervention with those expected for three prevention strategies: (1) intrapartum antibiotics administered to colonized women with labor complications, (2) an alternative strategy that does not require screening but uses epidemiologic criteria and labor complications to target intrapartum antibiotics, and (3) maternal vaccination. We used data from multistate population-based surveillance to estimate the potential impact of each strategy on disease and costs in the United States.


RESULTS
Intrapartum antibiotic prophylaxis of high-risk women identified by screening could prevent approximately 3300 cases (47% of neonatal disease) annually in the United States and could save approximately $16 million in direct medical costs. Chemoprophylaxis of high-risk women identified using epidemiologic criteria could potentially be equally effective (3200 cases prevented) and would avoid the logistical difficulties of screening; the net savings would be approximately $66 million. Vaccinating 80% of pregnant women with a vaccine that prevents 80% of cases among infants born at or after 34 weeks of gestation would prevent approximately 4100 neonatal cases annually with a net savings of $131 million.


CONCLUSIONS
Universal prenatal screening for GBS and chemoprophylaxis of colonized women with labor complications is likely to be cost-beneficial in the United States. Development of alternative strategies should be further explored for populations in which GBS screening is impractical. Continued development of a GBS vaccine is an important public health priority.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333.
J C
JC
Mohle-Boetani
A
A
Schuchat
B D
BD
Plikaytis
J D
JD
Smith
C V
CV
Broome
D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001428:Bacterial Vaccines / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D011297:Prenatal Exposure Delayed Effects; D013290:Streptococcal Infections / Q000191:economics* / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000276:immunology; D014481:United States
D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines