This study evaluated the cost effectiveness of universal COVID-19 screening versus universal PPE on transmission of COVID-19 to health care workers (HCW) on labor and delivery (L&D). Findings may help provide guidance regarding allocation of resources on L&D during current and future pandemics.

The authors developed a decision analytic model comparing these strategies using probabilities and costs derived from the literature. They used individual models to evaluate different scenarios including spontaneous labor, induced labor, and planned cesarean delivery (CD). The primary outcome was the cost to prevent COVID-19 infection in one HCW. A cost-effectiveness threshold was set at $25,000 to prevent a single infection in an HCW.

Using a COVID-19 prevalence of 0.36% (the rate in the United States at the time), their model favored universal screening as the preferred strategy. This was largely driven by the high costs of universal PPE, which is more effective at preventing COVID-19 transmission, but more costly, costing $4,175,229 and $3,413,251 to prevent one infection in the setting of spontaneous and induced labor, respectively. Universal PPE was cost saving for planned CD.

The model is sensitive to variations in the prevalence of COVID-19 and the cost of PPE. For example, universal PPE becomes cost-effective at a COVID-19 prevalence of 34.3 and 29.5% and at a PPE cost of $512.62 and $463.20 for spontaneous and induced labor, respectively. The model demonstrated that at a higher cost-effectiveness threshold, the prevalence of COVID-19 can be lower for universal PPE to become cost-effective.