Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California 94305, USA.
PEDIATRICS (Impact Factor: 5.47). 10/2002; 110(3):471-80. DOI: 10.1542/peds.110.3.471
Source: PubMed


To evaluate the costs and benefits of a group B streptococci screening strategy using a new, rapid polymerase chain reaction test in a hypothetical cohort of expectant mothers in the United States.

Cost-benefit analysis using the human capital method. We developed a decision model to analyze the costs and benefits of a hypothetical group B streptococci screening strategy using a new, rapid polymerase chain reaction test as compared with the currently recommended group B streptococci screening guidelines-prenatal culture performed at 35 to 37 weeks or risk-factor-based strategy with subsequent intrapartum treatment of the expectant mothers with antibiotics to prevent early-onset group B streptococcal infections in their infants.
A hypothetical cohort of pregnant women and their newborns.
Screening strategies for group B streptococci using the new polymerase chain reaction technique, the 35- to 37-week culture, or maternal risk factors.
Infant infections averted, infant deaths, infant disabilities, costs, and societal benefits of healthy infants.
A screening strategy using the new polymerase chain reaction test generates a net benefit of $7 per birth when compared with the maternal risk-factor strategy. For every 1 million births, 80 700 more women would receive antibiotics, 884 fewer infants would become infected with early-onset group B streptococci, and 23 infants would be saved from death or disability. The polymerase chain reaction-based strategy generates a net benefit of $6 per birth when compared with the 35- to 37-week prenatal culture strategy and results in fewer maternal courses of antibiotics (64 080 per million births), fewer perinatal infections with early-onset group B streptococci (218/million), and a reduction in 6 infant deaths and severe infant disability per million births. The benefits hold over a wide range of assumptions regarding key factors in the analysis.
Although additional clinical trials are needed to establish the accuracy of this new polymerase chain reaction test, initial studies suggest that strategies using this test will be superior to the other 2 strategies. Using the rapid polymerase chain reaction test becomes less attractive as the cost of the test increases. The test's greatest strengths lie in its ability to identify women and infants at risk at the time of labor, thereby decreasing the number of false-positives and false-negatives seen with the other 2 strategies and allowing for more accurate and effective intrapartum prophylaxis.

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    • "The most rapid method of GBS detection is currently by PCR at labor onset; this requires 24-hour laboratory staffi ng. Initial analysis suggests it would be cost-effective and the most accurate and effective method to determine intrapartum chemoprophylaxis (Haberland et al. 2002). Neonatal EOGBSD is diagnosed by positive blood culture, CSF, or CXR consistent with infection , supported by a positive urine streptococcal antigen, abnormal white cell count, elevated C reactive protein, or proinfl ammatory cytokine, for example, IL-6 (Jeffery 1996). "
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    ABSTRACT: Infection continues to account for a major proportion of maternal, fetal, and neonatal mortality and morbidity worldwide. In the developing world, maternal systemic infections, such as pneumonia, malaria, tuberculosis, typhoid fever, and pyelonephritis, which are often functions of poverty, crowding, and malnutrition, impose health costs to the mother and risks to the fetus. These risks include spontaneous abortion, stillbirth, preterm labor and preterm birth, low birth weight, intrauterine growth restriction (IUGR), and infection. This is in addition to the rapidly escalating rates of a number of sexually transmitted diseases, in particular, human immunodeficiency virus (HIV) infection with its associated comorbidities.
    Fetal and Neonatal Pathology, 07/2009: pages 379-423;
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    ABSTRACT: Background Group B streptococci (GBS) are the leading cause of sepsis and meningitis in newborns. The infection in the newborn is caused by GBS that colonize the birth canal. This review of possibilities for laboratory work-up of swabs for GBS screening in pregnant women was precipitated by findings that inappropriate laboratory procedures can significantly con- tribute to false negative results. Conclusions Most widely used guidelines for prevention of group B streptococcal disease are the guideli- nes from the US Centers for Disease Control. These guidelines include collection of cultures between 35 and 37 weeks' gestation and use of basic microbiological media. Research showed that there are significant differences in media performance, therefore media selec- tion is crucial. Data show that Granada agar has a better sensitivity than the CDC proce- dure. Nevertheless, in the future all culture-based screening methods will be replaced by rapid in-labor tests. Their biggest advantage is identifying newborns and mothers that are truly at risk.
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    ABSTRACT: We investigated ways of defining and measuring the value of services pro- vided by governmental public health systems. Our data sources included liter- ature syntheses and qualitative interviews of public health professionals. Our examination of the health economic literature revealed growing attempts to measure value of public health services explicitly, but few studies have addressed systems or infrastructure. Interview responses demonstrated no consensus on metrics and no connection to the academic literature. Key challenges for practi- tioners include developing rigorous, data-driven methods and skilled staff; being politically willing to base allocation decisions on economic evaluation; and developing metrics to capture ''intangibles'' (e.g., social justice and reassurance value). Academic researchers evaluating the economics of public health invest- ments should increase focus on the working needs of public health professionals. (Am J Public Health. 2008;98:2173-2180. doi:10.2105/AJPH.2007.127134)
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