title: Prevention of group B streptococcal disease in the first 3 months of life: would routine maternal immunization during pregnancy be cost-effective?
abstract: BACKGROUND
  A vaccine against group B streptococcus (GBS) that is intended for routine maternal immunization during pregnancy is in clinical development. Addition of vaccination to screening and intrapartum antibiotic prophylaxis (IAP) may further reduce the burden of GBS disease in infancy; its potential cost-effectiveness is unknown, however.
  
  
  METHODS
  We evaluated the cost-effectiveness of routine immunization at week 28 of pregnancy with the trivalent GBS (serotypes Ia, Ib and III) vaccine that is in clinical development. The vaccine was assumed to be used in addition to screening and IAP, and reduce the risk of invasive infection in infancy due to covered serotypes. We estimated the effectiveness of immunization in terms of additional cases of GBS disease prevented, deaths averted, life-years saved, and quality-adjusted life-years (QALYs) gained; potential reductions in prematurity and stillbirths were not considered. Costs considered included those of acute care for infants with GBS disease, and chronic care for those with long-term disability. The cost of immunization was assumed to be $100 per person.
  
  
  RESULTS
  Assuming 85% coverage, routine maternal immunization against GBS added to screening and IAP would prevent an additional 899 cases of GBS disease and an additional 35 deaths among infants in the US. The total annual cost of immunization would be $362.7 million; estimated cost savings from prevention of GBS disease in infancy would be $43.5 million. The cost-effectiveness of immunization was estimated to be $91,321 per QALY gained. Findings were sensitive to assumptions regarding vaccine efficacy and cost.
  
  
  CONCLUSIONS
  Addition of a trivalent GBS maternal vaccine to screening and IAP might further reduce the burden of GBS disease among infants in the US, and may be comparable in cost-effectiveness to other vaccines recently approved for use in children and adolescents.
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA. Electronic address: goster@pai2.com.
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA. Electronic address: edelsberg@pai2.com.
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA. Electronic address: khennegan@pai2.com.
authors.forename: Kalin
authors.initials: K
authors.lastname: Hennegan
authors.affiliation: Novartis Vaccines and Diagnostics, One Health Plaza, Building 431, 5(th) Floor, East Hanover, NJ 07936, USA. Electronic address: clement.lewin@novartis.com.
authors.forename: Clement
authors.initials: C
authors.lastname: Lewin
authors.affiliation: Novartis Vaccines, 300 Massachusetts Avenue, Cambridge, MA 02139, USA. Electronic address: vas.narasimhan@novartis.com.
authors.forename: Vas
authors.initials: V
authors.lastname: Narasimhan
authors.affiliation: Novartis Vaccines, 300 Massachusetts Avenue, Cambridge, MA 02139, USA. Electronic address: karen.slobod@novartis.com.
authors.forename: Karen
authors.initials: K
authors.lastname: Slobod
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, #302A, Houston, TX 77030, USA. Electronic address: morvene@bcm.edu.
authors.forename: Morven S
authors.initials: MS
authors.lastname: Edwards
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, #302A, Houston, TX 77030, USA; Department of Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM320, Houston, TX 77030, USA. Electronic address: cbaker@bcm.edu.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Baker
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D018803:Models, Economic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D013290:Streptococcal Infections / Q000517:prevention & control*; D022541:Streptococcal Vaccines / Q000191:economics* / Q000627:therapeutic use; D013292:Streptococcus agalactiae; D014481:United States; D014611:Vaccination / Q000191:economics*
chemical_list: D022541:Streptococcal Vaccines
keywords: Cost-effectiveness; Group B streptococcus; Maternal immunization