Costs and outcomes of group B Streptococcus (GBS) screening strategies in France for prevention of neonatal early-onset GBS disease

Objective Early-onset Group B Streptococcus (EOGBS) infection in neonates is prevented with intrapartum antibiotic prophylaxis (IAP). Traditionally, IAP candidates are identified via antepartum microbiological culture or clinical risk factors. While these strategies have reduced EOGBS incidence in many countries, some cases potentially preventable with IAP are missed. Point-of-care polymerase chain reaction (PCR) tests offer a promising alternative to detect intrapartum GBS colonization in near-patient settings and inform IAP use, addressing limitations of traditional approaches. Despite existing European clinical consensus recommending PCR-based intrapartum screening, its adoption is limited, partially due to lack of health economic data. The objective of this study was to assess the clinical and economic impact of EOGBS prevention strategies from a French healthcare system perspective.Methods We developed a decision-analytic model and an abbreviated budget impact model to simulate different EOGBS prevention strategies (antepartum and intrapartum screening, risk-factor-based IAP) among pregnant women with any combination of risk factors and their impact on EOGBS incidence. The model incorporated short-term costs related to GBS screening, IAP, EOGBS treatment, and lifetime costs and outcomes associated with long-term complications among infants who survive EOGBS (e.g. quality-adjusted life years [QALY]). For the reference case, we compared a strategy of intrapartum PCR screening of pregnant women without risk factors against universal antepartum culture screening.Results The model estimated that the intrapartum PCR screening strategy provided QALY gains at lower costs compared to the antepartum culture-based screening strategy, reducing EOGBS incidence by 14.14%, with 21,910 pregnant women tested intrapartum to prevent one EOGBS case. Applied to annual deliveries in France (2022), intrapartum PCR testing was projected to prevent 32 EOGBS cases and ∼2 EOGBS-related deaths per year compared to the antepartum culture-based screening strategy. The budget impact analysis indicated lower screening and EOGBS management costs with intrapartum PCR testing, with estimated annual savings of €895,711 for the French healthcare system.Conclusion An EOGBS prevention strategy incorporating intrapartum PCR screening may reduce EOGBS incidence and healthcare costs for the French healthcare system compared to current antepartum culture-based screening practices.