THE PEDIATRIC COSTS OF STRATEGIES FOR MINIMIZING THE RISK OF EARLY-ONSET GROUP-B STREPTOCOCCAL DISEASE

Objective: To estimate the pediatric costs associated with the Centers for Disease Control and Prevention (CDC) guidelines for the managemen t of infants born to mothers receiving intrapartum antimicrobial proph ylaxis for prevention of early-onset group B streptococcal disease. Me thods: For an annual United States birth cohort of 3.95 million infant s, we estimated the cost of pediatric care provided to full-term asymp tomatic infants when pediatricians followed the CDC algorithm for the management of infants exposed to intrapartum antimicrobial prophylaxis under culture-based and risk factor-based maternal care approaches. W e calculated the relative contribution of pediatric costs to the total costs of preventing a case of early-onset group B streptococcal sepsi s. Results: Total pediatric costs were $41 million for a culture-based approach and $33 million for a risk factor-based approach. Hospital a nd physician costs accounted for more than 78% of this total. The majo rity (over 95%) of the pediatric costs were associated with vaginal de liveries. Incorporating pediatric costs into previous cost-effectivene ss analyses increased the cost per sepsis case averted by as much as 5 1% for culture-based strategies and by as much as 112% for risk factor -based strategies. Pediatric costs varied with the average length of s tay for full-term infants and with the average cost of a hospital day. Conclusion: Substantial pediatric costs are associated with the imple mentation of an obstetric strategy for minimizing the risk of early-on set group B streptococcal disease. Such costs should be included in fu ture cost-effectiveness analyses of different strategies for minimizin g the risk of group B streptococcal disease in newborns. (C) 1997 by T he American College of Obstetricians and Gynecologists.