title: Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis.
abstract: To estimate the cost-effectiveness of universal group B streptococci (GBS) screening in women with a singleton pregnancy planning a repeat cesarean delivery.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division 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.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Albright
authors.forename: Caitlin
authors.initials: C
authors.lastname: MacGregor
authors.forename: Desmond
authors.initials: D
authors.lastname: Sutton
authors.forename: Meena
authors.initials: M
authors.lastname: Theva
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Hughes
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
mesh_terms: D019072:Antibiotic Prophylaxis / Q000191:economics*; D002585:Cesarean Section; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control; D007743:Labor, Obstetric; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011300:Preoperative Care / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012007:Rectum / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis*; D013292:Streptococcus agalactiae; D014621:Vagina / Q000382:microbiology