High‐throughput, non‐invasive prenatal testing for fetal Rhesus D genotype to guide antenatal prophylaxis with anti‐D immunoglobulin: a cost‐effectiveness analysis. (15th March 2018) - Saramago, P
Abstract : Objective: To evaluate the cost‐effectiveness of high‐throughput, non‐invasive prenatal testing (HT‐NIPT) for fetal Rhesus D (RhD) genotype to guide antenatal prophylaxis with anti‐D immunoglobulin compared with routine antenatal anti‐D immunoglobulin prophylaxis (RAADP). Design: Cost‐effectiveness decision‐analytic modelling. Setting: Primary care. Participants: A simulated population of 100 000 RhD‐negative women not known to be sensitised to the RhD antigen. Methods: A decision tree model was used to characterise the antenatal care pathway in England and the long‐term consequences of sensitisation events. The diagnostic accuracy of HT‐NIPT was derived from a systematic review and bivariate meta‐analysis; estimates of other inputs were derived from relevant literature sources and databases. Women in whom the HT‐NIPT was positive or inconclusive continued to receive RAADP, whereas women with a negative result received none. Five alternative strategies in which the use of HT‐NIPT may affect the existing postpartum care pathway were considered. Main outcome measures: Costs expressed in 2015GBP and impact on health outcomes expressed in terms of quality‐adjusted life‐years over a lifetime. Results: The results suggested that HT‐NIPT appears cost saving but also less effective than current practice, irrespective of the postpartum strategy evaluated. A postpartum strategy in which inconclusive test results are distinguished from positive results performed best. HT‐NIPT is only cost‐effective when the overall test cost is £26.60 or less. Conclusions: HT‐NIPT would reduce unnecessary treatment with routine anti‐D immunoglobulin and is cost saving when compared with current practice. The extent of any savings and cost‐effectiveness is sensitive to the overall test cost. Tweetable abstract: HT‐NIPT is cost saving compared with providing anti‐D to all RhD‐negative pregnant women. Tweetable abstract: HT‐NIPT is cost saving compared with providing anti‐D to all RhD‐negative pregnant women.