CC BY-NC-ND 4.0 · AJP Rep 2019; 09(03): e315-e322
DOI: 10.1055/s-0039-1695744
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Universal versus Risk-Based Management of Unknown Group B Streptococcus Status at Term

Danielle M. Jones
1  School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada
,
Samantha O. Haikal
2  College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada
,
Megan D. Whitham
3  Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
David L. Howard
1  School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada
2  College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada
4  Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada
› Author Affiliations
Funding No funding was secured for this study.
Further Information

Publication History

18 March 2019

14 May 2019

Publication Date:
30 September 2019 (online)

  

Abstract

Objectives This article estimates and compares public health costs of universal versus risk-based intrapartum antibiotic prophylaxis (IAP) administration for women with unknown Group B streptococcus (GBS) status at term.

Study Design The annual number of women in the U.S. who are: unscreened for GBS, without risk factors, delivering vaginally, multiparous, and eligible for discharge within 24 hours was estimated. Under the risk-based strategy, women and neonates were assumed to stay another day for observation and incur the cost of an additional 24-hour stay. With universal IAP administration, women delivering without complications were assumed to be discharged within 24 hours, with an incurred cost of penicillin.

Results The estimated cost for the risk-based management of unscreened women at term without rupture of membranes (ROM) > 18 hours ranged from $468,886,831 to $850,556,179. Similarly, the cost of managing unscreened women without maternal intrapartum fever (MIF) ranged from $742,024,791 to $919,269,233. Alternatively, universal IAP administration costs ranged from $470,107,674 to $568,359,086.5. Cost comparisons yielded an equivalence or up to a 33.2% reduction in cost, and 36.6 to 38.2% reduction in cost for women without ROM > 18 hours and MIF, respectively.

Conclusions Universal IAP may be cost saving due to the reduction in extended hospitalizations for neonates and healthy mothers.

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.