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Testing for maternal group B streptococci during labor is more cost effective than current screening strategies

Over 2,000 U.S. infants each year are infected with group B streptococcus (GBS) in the first 7 days of life (early-onset GBS, EOGBS). These infants can develop cerebral palsy or die. However, with good maternal GBS screening techniques and timely infusion of antibiotics to the mother during labor, the majority of these neonatal infections can be prevented.

Giving antibiotics to the mother during labor eradicates vaginal GBS infection and prevents its spread to the fetus and infection of the infant during passage through the birth canal. Use of a rapid and accurate polymerase chain reaction (PCR) test to detect maternal GBS infection during labor is more cost effective than two current screening strategies, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00028).

Researchers from Stanford University and the Veterans Affairs Palo Alto Health Care System performed a cost-benefit analysis using the human capital method. They examined the potential health benefits, costs, and savings associated with three alternative strategies for identifying and treating a hypothetical group of pregnant women at risk for passing GBS infection on to their infants: use of the new rapid PCR (45-minute results with 100 percent sensitivity and 98.9 percent specificity) at the time of hospital admission for labor; the standard maternal rectovaginal culture at 35-37 weeks of pregnancy; and screening for maternal risk factors for GBS infection at the time of labor.

A screening strategy using the new rapid PCR generated 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 EOGBS, and 23 infants would be saved from death or disability. The PCR-based strategy generated a net benefit of $6 per birth when compared with the 35-37-week prenatal culture strategy and would result in fewer maternal courses of antibiotics (64,080/million births), fewer perinatal infections with EOGBS (218 per million births), and a reduction in 6 infant deaths and severe infant disability per million births.

See "Perinatal screening for group B streptococci: Cost-benefit analysis of rapid polymerase chain reaction," by Corinna A. Haberland, M.D., William E. Benitz, M.D., Gillian D. Sanders, Ph.D., and others, in the September 2002 Pediatrics 110(3), pp. 471-480.

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