Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization
Table 3
Estimated effects and costs (in 2008 USD) of the different treatment strategies compared with a situation without treatment for a birth cohort of 300 000 infants born to mothers colonized with GBS in a previous pregnancy (3% discounting).
Screen and treat strategy
Universal treatment strategy
Effects
EOGBS cases prevented
1700
1732
Deaths due to EOGBS prevented
51
52
QALY gained
1607
1637
Range*
Range*
Cost (in dollars)
Costs of screening
15 000 000
9 000 000–22 500 000
NA
Cost of IAP with penicillin
2 503 778
1 280 519–3 784 297
6 106 776
3 123 216–9 229 992
Cost of screening and treating women with a history of a penicillin allergy
154 551
79 011–233 562
223 856
113 664–337 519
Treatment for maternal anaphylaxis and death
2 658 264
2 188 173–3 339 396
6 293 596
5 178 717–7 910 099
Cost of limited evaluation of well infants whose mothers received <4 hours of IAP
1 104 569
568 064–2 114 460
2 617 008
1 345 890–5 009 702
Cost of CBC of well infants whose mother was negative for GBS
185 850
99 120–507 990
9 367
4 996–25 603
Total costs for treatment of term GBS sepsis cases
−24 719 871
20 528 650–28 910 788
−22 111 508
18 362 532–25 860 213
Total costs of intervention
21 607 013
13 214 887–32 479 706
15 250 603
9 766 483–22 512 915
Numbers needed to treat per GBS case prevented
67
155
Cost-effectiveness (in dollars)
Cost savings per QALY gained
72 878
78 100–66 112
77 006
80 355–72 570
Cost for each GBS case prevented
12 710
7 773–19 105
8 805
5 639–12 998
Benefit-cost ratio
6.4
10 5–4.3
9.3
14.5–6.3
Total annual costs net benefits
141 835 784
150 227 910–130 963 091
148 192 194
153 676 314–140 929 882
EOGBS: early onset group B streptococci; QALY: quality-adjusted life-year gained; IAP: intrapartum antibiotic prophylaxis; GBS: group B streptococci; CBC: complete blood count. NA: not applicable.
*Range: it is the cost utilizing the baseline probability estimates from Table 1 and the lowest to the highest estimates shown in Table 2.
