PEDIATRICS Sep 2002 VOL. 110 NO. 3               Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction Corinna A. Haberland, MD*; William E. Benitz, MD‡; Gillian D. Sanders, PhD*; Jan Benjamin Pietzsch, MS§; Sanae Yamada, MBA; Lan Nguyen, MBA; and Alan M. Garber, MD, PhD*¶ ABSTRACT. Objective. To evaluate the costs and benefits of a group B streptococci screening strategy us- ing a new, rapid polymerase chain reaction test in a hypothetical cohort of expectant mothers in the United States. Methods. Design. Cost-benefit analysis using the hu- man 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 poly- merase chain reaction test as compared with the currently recommended group B streptococci screening guide- lines—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. Participants. A hypothetical cohort of pregnant women and their newborns. Interventions. Screening strategies for group B strepto- cocci using the new polymerase chain reaction technique, the 35- to 37-week culture, or maternal risk factors. Outcome Measures. Infant infections averted, infant deaths, infant disabilities, costs, and societal benefits of healthy infants. Results. A screening strategy using the new polymer- ase chain reaction test generates a net benefit of $7 per birth when compared with the maternal risk-factor strat- egy. For every 1 million births, 80 700 more women would receive antibiotics, 884 fewer infants would be- come 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. Conclusions. 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. Pediatrics 2002; 110:471– 480; Streptococcus agalactiae, streptococcal in- fections, mass screening, cost-benefit analysis. ABBREVIATIONS. GBS, group B -hemolytic Streptococcus; EOGBS, early-onset group B streptococcal (disease); AAP, Amer- ican Academy of Pediatrics; CDC, Centers for Disease Control and Prevention; PCR, polymerase chain reaction; NICU, neonatal in- tensive care unit; PPV, positive predictive value; NPV, negative predictive value; LPCH, Lucile Salter Packard Children’s Hospi- tal; IV, intravenous; OSHPD, Office of Statewide Health Planning and Development. G roup B -hemolytic Streptococcus (GBS) is one of the leading causes of neonatal infection in the United States and other Western coun- tries. Early-onset group B streptococcal (EOGBS) dis- ease, defined as infection in the first 7 days of life, is the most common type of GBS infection in infants, accounting for 60% to 80% of GBS cases in new- borns 1,2 and an estimated 2000 cases per year. 3,4 Clinical studies in the 1980s demonstrated that intra- partum antibiotic prophylaxis of mothers colonized From the *Center for Primary Care and Outcomes Research, Stanford Uni- versity School of Medicine, Stanford, California; ‡Department of Pediatrics, Stanford University School of Medicine, Stanford, California; §Department of Management Science and Engineering, School of Engineering, Stanford University, Stanford, California; Graduate School of Business, Stanford University, Stanford, California; and ¶Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Received for publication Sep 4, 2001; accepted Apr 24, 2002. Address correspondence to Corinna A. Haberland, MD, Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305. E-mail: haber@healthpolicy.stanford.edu. PEDIATRICS (ISSN 0031 4005). Copyright © 2002 by the American Acad- emy of Pediatrics. PEDIATRICS Vol. 110 No. 3 September 2002 471