Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost‐effective in the United States?. (24th January 2019)

• Record Type: Journal Article
• Authors: Moise, Kenneth J.; Hashmi, Syed Shahrukh; Markham, Kara; Argoti, Pedro S.; Bebbington, Michael
• Is Part Of: Prenatal diagnosis. Volume 39:Number 3(2019)
• Page Start: 238
• Page End: 247
• Publication Date: 2019-01-24
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5415
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract : What is already known about this topic? Cell free DNA can accurately predict the fetal RHD status. What does this study add? Use of cell free DNA to determine the fetal RHD status to triage the use of antenatal rhesus immune globulin is not a cost‐effective strategy for implementation in the United States. Universal rhesus antenatal immune globulin without consideration for paternity is the most effective strategy for preventing new cases of RhD alloimmunization. Abstract: Objective: To compare the efficacy and costs of three different strategies of antenatal rhesus immune globulin (RhIG) administration in a US population. Methods: A decision tree analysis was undertaken for universal antenatal RhIG administration based on RhD serologic paternity testing, universal administration without paternity, and selective antenatal RhIG administration using cell free fetal DNA (cfDNA) for RHD fetal typing. Rates of alloimmunization were calculated. Charges were determined for laboratory testing and obstetrical and neonatal treatments for the first pregnancy and cases of alloimmunization in the following pregnancy. Results: The largest number of new RhD alloimmunization cases resulted from a strategy of universal RhIG that included paternity. Fewer cases resulted from a selective strategy; the least number of cases were associated with a universal approach that discounted paternity. When the costs of first pregnancies and alloimmunized second pregnancies were combined, a universal strategy that excludes paternity had the least costs followed by a selective strategy followed by a universal strategy that included paternity. Conclusion: The use of cfDNA to determine the selective use of antenatal RhIG would not be cost‐effective in the United States. Universal antenatal RhIG without paternity is more effective in preventing new cases of alloimmunization than the current ACOG guideline.