Abstract
Objectives
To assess the cost-effectiveness of high-throughput non-invasive prenatal testing (HT-NIPT) for fetal rhesus D (RhD) status in avoiding unnecessary prophylactic anti-D immunoglobulin treatment in RhD-negative women found to be carrying an RhD-negative fetus.
Methods
A probabilistic cohort model was used to describe the antenatal care pathway and the long-term consequences of sensitisation events (e.g. miscarriage). The performance of HT-NIPT was derived from a systematic review and bivariate meta-analysis of 3 UK studies. Estimates of other relevant parameters were derived from literature sources. Five alternative strategies in which the use of HT-NIPT may impact on the existing post-partum care pathway were considered. A UK health service perspective was used and lifetime costs and effects were discounted at an annual rate of 3.5%. Sensitivity analysis was performed to key model parameters.
Results
The results indicated that HT-NIPT appeared cost saving but also less effective than current practice, irrespective of the post-partum scenario evaluated. Potential cost-savings with HT-NIPT appeared sufficient to outweigh the QALY loss associated with the small increase in sensitisations. A post-partum strategy, in which inconclusive test results are distinguished from positive results, was considered the optimal strategy. The results were also sensitive to the cost of the HT-NIPT.
Conclusions
HT-NIPT would reduce unnecessary treatment with anti-D immunoglobulin and appears cost saving when compared to current practice of providing prophylactic anti-D immunoglobulin to all RhD-negative pregnant women. The extent of any savings is highly sensitive to the additional cost that introduction of HT-NIPT would impose on the antenatal care pathway.
To assess the cost-effectiveness of high-throughput non-invasive prenatal testing (HT-NIPT) for fetal rhesus D (RhD) status in avoiding unnecessary prophylactic anti-D immunoglobulin treatment in RhD-negative women found to be carrying an RhD-negative fetus.
Methods
A probabilistic cohort model was used to describe the antenatal care pathway and the long-term consequences of sensitisation events (e.g. miscarriage). The performance of HT-NIPT was derived from a systematic review and bivariate meta-analysis of 3 UK studies. Estimates of other relevant parameters were derived from literature sources. Five alternative strategies in which the use of HT-NIPT may impact on the existing post-partum care pathway were considered. A UK health service perspective was used and lifetime costs and effects were discounted at an annual rate of 3.5%. Sensitivity analysis was performed to key model parameters.
Results
The results indicated that HT-NIPT appeared cost saving but also less effective than current practice, irrespective of the post-partum scenario evaluated. Potential cost-savings with HT-NIPT appeared sufficient to outweigh the QALY loss associated with the small increase in sensitisations. A post-partum strategy, in which inconclusive test results are distinguished from positive results, was considered the optimal strategy. The results were also sensitive to the cost of the HT-NIPT.
Conclusions
HT-NIPT would reduce unnecessary treatment with anti-D immunoglobulin and appears cost saving when compared to current practice of providing prophylactic anti-D immunoglobulin to all RhD-negative pregnant women. The extent of any savings is highly sensitive to the additional cost that introduction of HT-NIPT would impose on the antenatal care pathway.
| Original language | English |
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| DOIs | |
| Publication status | Published - 2017 |
| Event | ISPOR 20th Annual European Conference - Glasgow, United Kingdom Duration: 6 Nov 2017 → 8 Nov 2017 |
Conference
| Conference | ISPOR 20th Annual European Conference |
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| Country/Territory | United Kingdom |
| City | Glasgow |
| Period | 6/11/17 → 8/11/17 |