High-throughput, non-invasive prenatal testing for fetal RHD genotype to guide antenatal prophylaxis with anti-D immunoglobulin: a cost-effectiveness analysis

TY - JOUR

T1 - High-throughput, non-invasive prenatal testing for fetal RHD genotype to guide antenatal prophylaxis with anti-D immunoglobulin

T2 - a cost-effectiveness analysis

AU - Saramago Goncalves, Pedro Rafael

AU - Yang, Huiqin

AU - Llewellyn, Alexis

AU - Palmer, Stephen John

AU - Simmonds, Mark Crawford

AU - Griffin, Susan

N1 - This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

PY - 2018/2/7

Y1 - 2018/2/7

N2 - OBJECTIVE: To evaluate the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal RhD genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared to 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, while women with a negative result received none. Five alternative strategies in which the use of HT-NIPT may affect the existing post-partum care pathway were considered.MAIN OUTCOME MEASURES: Costs expressed in 2015GBP and impact on health outcomes expressed in terms of quality adjusted life years (QALYs) over a lifetime.RESULTS: The results suggested that HT-NIPT appears cost saving but also less effective than current practice, irrespective of the post-partum strategy evaluated. A post-partum 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 to current practice. The extent of any savings and cost-effectiveness is sensitive to the overall test cost. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: To evaluate the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal RhD genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared to 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, while women with a negative result received none. Five alternative strategies in which the use of HT-NIPT may affect the existing post-partum care pathway were considered.MAIN OUTCOME MEASURES: Costs expressed in 2015GBP and impact on health outcomes expressed in terms of quality adjusted life years (QALYs) over a lifetime.RESULTS: The results suggested that HT-NIPT appears cost saving but also less effective than current practice, irrespective of the post-partum strategy evaluated. A post-partum 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 to current practice. The extent of any savings and cost-effectiveness is sensitive to the overall test cost. This article is protected by copyright. All rights reserved.

KW - Journal Article

U2 - 10.1111/1471-0528.15152

DO - 10.1111/1471-0528.15152

M3 - Article

C2 - 29415334

JO - BJOG: an International Journal of Obstetrics and Gynaecology

JF - BJOG: an International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -