Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: a prospective comparison of effectiveness and costs. Immune Thrombocytopenia Working Group.
A prospective study was conducted in three maternity wards to compare the medical outcomes and the costs of two screening strategies for the detection of fetal/neonatal alloimmune thrombocytopenia (FMAIT). A total of 2066 primiparas and 6081 newborns were included. Fifty-two primiparous women with HPA-1b phenotype were found, and 45 were followed during pregnancy. Four women developed antibodies, and two fetuses exhibited FMAIT; therefore, the prevalence of anti-HPA-1a was 2 per 1000, and the prevalence of FMAIT 1 per 1000. Forty-eight thrombocytopenic newborns were found out of a total of 5632 blood samples. Five were HPA-1a children whose mothers were HPA-1b. The cost-effectiveness of screening all primiparous women was $45,000 and of screening all newborns is $18,000-per anti-HPA-1a alloimmunization diagnosed. Costs per fetal death or disability averted were $500,000 for the primiparous strategy and $225,000 for the newborn strategy. In conclusion, screening newborns for neonatal alloimmune thrombocytopenia is more cost-effective than screening primiparous women.
Durand-Zaleski
I
I
Départment of Public Health, Hôpital Henri Mondor, Créteil, France.
Schlegel
N
N
Blum-Boisgard
C
C
Uzan
S
S
Dreyfus
M
M
Kaplan
C
C
D016824:Antigens, Human Platelet / Q000276:immunology*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D000939:Epitopes / Q000276:immunology*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics*; D015997:Neonatal Screening / Q000191:economics*; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000175:diagnosis / Q000517:prevention & control*
D016824:Antigens, Human Platelet; D000939:Epitopes; C083451:human platelet antigen 1b