Health Policy / EthicsCost-Effectiveness of the Management of Rh-Negative Pregnant Women
Section snippets
INTRODUCTION
Despite the availability of prophylactic measures, alloimmunization to the Rh(D) antigen during pregnancy remains the most common cause of hemolytic disease of the newborn (1:1000 newborns).1 Alloimmunization is the occurrence of an immune response to the presence of an antigen (alloantigen) that an individual lacks, but that is present in other individuals of the same species. In humans, this situation is observed only in special circumstances: pregnancy (immunization of an Rh-negative mother
METHODS
We built a virtual population of 10 000 Rh-negative pregnant women. This number was considered sufficient to perform statistically meaningful simulations given that 150 cases of Rh(D) incompatibility would be expected. The model assumed that 55% of women will have a second pregnancy,20 on average 3.15 years after the first.21 The Rh type of the fetus was established based on the probability of the father being either homozygously or heterozygously Rh positive.22
Besides the estimated costs, two
RESULTS
When the development of HDF and neonatal survival at 28 days were considered as clinical outcomes, two options emerged as the most cost-effective: routine prophylaxis and immunological Rh typing of the father in the first pregnancy (Table 3). However, confidence intervals overlapped between these options.
In the second pregnancy, when the outcome of number of babies without HDF was considered, the immunological Rh typing of the father emerged as the most cost-effective option (Table 4). When
DISCUSSION
Our results suggest that the four proposed strategies for prevention and treatment of Rh(D) alloimmunization are similar in terms of effectiveness. This was expected as all the options include giving anti-D IgG prophylaxis to women who need it. Moreover, the specificity and sensitivity of both fetal genotyping and immunological Rh typing of the father are high, which means that women who need prophylaxis are generally properly identified. In addition, all women who refuse testing (30%) either
CONCLUSION
Until automation of Rh(D) fetal genotyping is implemented and the cost of screening falls below $140, immunological Rh typing of the father and routine anti-D IgG prophylaxis are the most cost-effective options. Because routine immunological Rh typing of the father would probably not be adopted by the majority of Canadian clinicians, routine prophylaxis remains the preferred option, as recommended by the Canadian guidelines for the prevention of maternal–fetal Rh alloimmunization.
ACKNOWLEDGEMENTS
The work that led to this manuscript was supported by a grant from the Canadian Institutes for Health Research (grant number CFBA-49658), and also in part by the FQR-S Réseau de médecine génétique appliquée, and the APOGÉE-Net/CanGèneTest Research and Knowledge Network in Genetic health Services, funded by the Canadian Institutes for Health Research (www.cangenetest.org), (grant number ETG-92250). This work also involved the FRSQ/MSSS/CHUQ Research Chair in Technology Assessment and
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Noninvasive Fetal RhD Blood Group Genotyping: A Systematic Review of Economic Evaluations
2021, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Three studies reported on neonatal outcomes such as the number of healthy babies born,20,21,23 number of newborns without HDFN,23 and number of newborns with serious morbidity or who died owing to HDFN20 (Table 1). It is unclear how and why HDFN was modeled and detected in the first (nonalloimmunized) pregnancy in one study.23 The U.K. CEA17 was the only study to estimate the QALYs of the newborn associated with the consequences of HDFN through inclusion of the two health states (a temporary one accounting for minor developmental problems such as myopia or delay in language and fine motor skills, and a lifetime health state associated with major developmental problems such as bilateral deafness or severe neurodevelopmental delay).
De la tragédie au triomphe: Apports canadiens dans la prise en charge de la maladie hémolytique du nouveau-né en raison d'une incompatibilité liée au facteur rhésus
2019, Journal of Obstetrics and Gynaecology CanadaFrom Tragedy to Triumph: Canadian Connections in the Management of Rhesus Hemolytic Disease of the Newborn
2019, Journal of Obstetrics and Gynaecology CanadaNo. 343-Routine Non-invasive Prenatal Prediction of Fetal RHD Genotype in Canada: The Time is Here
2017, Journal of Obstetrics and Gynaecology CanadaNo. 343 - Routine non-invasive prenatal prediction of fetal RHD genotype in Canada: The time is here
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Competing Interests: None declared.