Background: Intrapartum chemoprophylaxis (ICP) is effective in the prevention of early-onset GBS disease (EOD). The Am. Acad. of Pediatr.(AAP) recommends universal GBS screening at 28 wk. and selective ICP of GBS culture-positive, high risk patients. The Am. College of Obstet. and Gynecol.(ACOG) advocates non-selective ICP based on risk factors alone. The Centers for Disease Control (CDC) has recently recommended a combined approach of GBS screening at 37 wk. and nonselective ICP based on risk factors. Aim: The study was designed to test the CE of the CDC recommendation. Design and method: We performed a decision analysis comparing the three strategies along with no prevention strategy (No). We focused on three main outcomes:1) number of expected cases of EOD 2) total cost3) Cost-effectiveness ratio (CER). The number of live births in the greater Cincinnati area was used as sample size (29,233 births in 1994). Probability estimates (Pr) were derived from literature search (JAMA 270:1442). We estimated total and intervention costs (Obstet Gynecol, 83:483, and from U. Cincinnati Hospital charges). CER was calculated as Intervention cost / no. of GBS cases prevented. Results:Table Conclusions: CDC strategy has the highest costs, the lowest pr. of neonatal disease, and is least cost-effective. ACOG strategy has the lowest costs, the highest pr. of neonatal disease, and is most cost-effective. To summarize based on principle and decision strategy: Table

Table 1
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Table 2
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