Potential Fiscal Consequences of Universal Screening for Group-B Streptococci

The proposed recommendation for extensive screening for group-B streptococci (GBS) during pregnancy published in the Federal Registe? and advocated by the American Academy of Pediatrics will have an impact on health-care economics to varying extents in at least 2 areas. Implementation of the pending mandate for universal screening will 1) require direct funding to expand the current proactive prenatal infectious-disease screening and 2) indirectly fuel the fiscal consequences of failure. The cost efficiency of universal screening for GBS vs. situationally dictated prophy-laxis has been approximated. The CDC cited the analysis of Stray-Pederson in indicating that the cost per case prevention was <$35,000. The aggregate studies of Boyer and Gotoff as well as that of Strickland et al. and Yancey and Duff similarly support this contention. Based on the high cost of caring for neonates with early-onset disease ($22,000-33,800), the policy of screening and treatment has been projected to be economically justified. 1'6 Gibbs et al. reviewed the 2-year experience of a universal screening program with strict application of criteria and found the compliance rate in administering indicated prophylaxis with a complex algorithm to be only 80.3%. The incidence of GBS sepsis in the last year's protocol was 0.5 per 1,000 live births. Of the 5 cases of early-onset neonatal GBS, 4 were due to a failure to identify GBS with the initial screening culture. All 3 of the 4 cases were said to be protocol violations attributed to nonselective media. The majority of hospital laboratories do not use selective media in screening for GBS. The reason is simply that, because of the additional steps required to process a specimen for GBS, the use of selected media markedly increases the cost of culturing. Had selective broth media been used, there is no absolute guarantee that the cultures would have been positive for GBS. The recommendations for universal screening as advocated by the American Academy of Pediatrics are predicated upon the desire to bring the number of cases of early-and late-onset GBS neonatal disease to zero. The proposal for universal screening deviates significantly from the prior recommendations of Minkoff and Mead and the more formal policy advocated in 1992 by the American College of Obstetricians and Gynecologists (ACOG). What would be the difference in terms of serious residual sequelae or death as a result of GBS neonatal disease between universal culturing and selective prophylaxis vs. selective prophylaxis? The projected numbers are exceedingly …