Saramago Goncalves, Pedro Rafael orcid.org/0000-0001-9063-8590, Yang, Huiqin orcid.org/0000-0003-3985-986X, Llewellyn, Alexis orcid.org/0000-0003-4569-5136 et al. (3 more authors) (2018) High-throughput, non-invasive prenatal testing for fetal RHD genotype to guide antenatal prophylaxis with anti-D immunoglobulin : a cost-effectiveness analysis. BJOG : an international journal of obstetrics and gynaecology. ISSN 1471-0528
Abstract
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.
Metadata
Authors/Creators: |
|
||||
---|---|---|---|---|---|
Copyright, Publisher and Additional Information: | 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 | ||||
Keywords: | Journal Article | ||||
Dates: |
|
||||
Institution: | The University of York | ||||
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Social Sciences (York) > Centre for Reviews and Dissemination (York) |
||||
Funding Information: |
|
||||
Depositing User: | Pure (York) | ||||
Date Deposited: | 12 Feb 2018 14:20 | ||||
Last Modified: | 06 Jan 2024 00:32 | ||||
Published Version: | https://doi.org/10.1111/1471-0528.15152 | ||||
Status: | Published online | ||||
Refereed: | Yes | ||||
Identification Number: | https://doi.org/10.1111/1471-0528.15152 |
Download
Filename: NIPT_CE_main_ReRevision_012018_final.docx
Description: NIPT_CE_main_ReRevision_012018_final