Noninvasive fetal RHD RHD genotyping of RhD RhD negative pregnant women for targeted anti‐ D D therapy in Australia: A cost‐effectiveness analysis

摘要

Abstract Objective To undertake a cost‐effectiveness analysis of noninvasive fetal RHD genotyping to target pregnant women for antenatal anti‐D prophylaxis therapy. Method A decision‐analytic model was constructed to compare RHD testing and targeted anti‐D prophylaxis, with current universal anti‐D prophylaxis among pregnant women with RhD negative blood type. Model estimates were derived from national perinatal statistics, published literature, donor program records, and national cost sources. One‐way sensitivity analyses addressed the uncertainty of variables on the main findings. Results The unit cost for RHD genotyping was estimated at AU$45.48 (US$31.84). The “mean cost per healthy baby” was AU$7495 (US$5247) for universal prophylaxis and AU$7471 (US$5230) for targeted prophylaxis. The findings were sensitive to the unit costs of anti‐D 625?IU (AU$59‐AU$88) (US$41‐US$62), the genetic test (AU$36‐AU$55) (US$25‐US$39), and packaging/transport costs of the samples for testing (AU$15‐AU$40, US$11‐US$28 per sample). With RHD genotyping, 13?938 women would avoid antenatal anti‐D prophylaxis at a total cost savings to the National Blood Authority of AU$2.1 million (US$1.5 million) per year. To the health system, net cost savings of AU$159?701 (US$111?791) per year (0.05%) were predicted for total health care costs. Conclusions Given the vulnerable supply of donor plasma and other health concerns, RHD genotyping is an economically sound option for Australia.