April 5th, 2020

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Universal Screening for Group B Streptococcus Versus Universal Treatment in Pregnant Women in Appalachia: Unintended Cost Shifting Consequences
Authors:  Edward Kowal, M.D., Byron C. Calhoun, M.D., FACOG, FACS, FASAM, MBA, Dara J. Seybold, M.A.A., David L. Williams, M.D., FACOG, and Paul P. Dietz, M.D., FACOG
  OBJECTIVE: To evaluate the cost of universal screening for Group B streptococcus (GBS) cultures in pregnancy as compared to the universal treatment of GBS in pregnant women in labor.

STUDY DESIGN: This retrospective study cohort population included all delivering patients from 1/1/17 to 12/31/17 managed by universal GBS screening in pregnancy with routine GBS cultures at 35–37 weeks’ gestation as compared to universal treatment in labor.
RESULTS: Of 622 routine culture patients, there were 34/622 (5%) positive GBS cultures, with 13 neonates with culture-positive GBS sepsis (13/622). We noted a $21,148 cost savings ($73,396–$52,248) in universal treatment to the system and a decrease by the 155.5 hours in the number of clinic personnel hours expended for GBS cultures. This reduction in clinic hours would be offset by the increase in pharmacy and nursing hours in Labor and Delivery (L&D) of 248.2 hours (415 hours–[155.5+11.3 hours]).

CONCLUSION: Universal treat for GBS would provide a savings of both money ($21,148) and time (155.5 hours of clinic personnel time). These savings in time in the clinic would be offset by an increase in the pharmacy and nursing hours. Future study of the implementation of routine antibiotic therapy in L&D with elimination of routine GBS cultures needs to be evaluated.
Keywords:  antibiotic prophylaxis; cost benefit analysis; group B streptococcal infection; group B streptococcus; infant, newborn; infant, newborn, diseases/prevention & control; infectious disease transmission, vertical; mass screening; pregnancy; pregnancy complications, infectious/prevention & control; prenatal care; risk factors; sepsis/prevention & control; streptococcal infections; streptococcal vaccines; United States/epidemiology
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