Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis

Obstet Gynecol. 2017 Jan;129(1):111-119. doi: 10.1097/AOG.0000000000001800.


Objective: To estimate the cost-effectiveness of universal group B streptococci (GBS) screening in women with a singleton pregnancy planning a repeat cesarean delivery.

Methods: 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.

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.

Conclusion: 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.

MeSH terms

  • Antibiotic Prophylaxis / economics*
  • Cesarean Section*
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / economics*
  • Infectious Disease Transmission, Vertical / prevention & control
  • Labor, Obstetric
  • Mass Screening / economics*
  • Pregnancy
  • Preoperative Care / economics
  • Quality of Life
  • Quality-Adjusted Life Years
  • Rectum / microbiology
  • Streptococcal Infections / diagnosis*
  • Streptococcus agalactiae*
  • Vagina / microbiology