title: Cost-effectiveness of the management of rh-negative pregnant women.
abstract: OBJECTIVE
  The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor.
  
  
  METHODS
  A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father's Rh type; (4) mixed screening: immunological determination of the father's Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants.
  
  
  RESULTS
  In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option.
  
  
  CONCLUSIONS
  Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.
authors.affiliation: Département de médecine sociale et préventive, Université Laval, Québec, Québec.
authors.forename: Julie
authors.initials: J
authors.lastname: Duplantie
authors.affiliation: Département de médecine sociale et préventive, Université Laval, Québec, Québec.
authors.forename: Odilon Martinez
authors.initials: OM
authors.lastname: Gonzales
authors.affiliation: Département de génie électrique et génie informatique, Université Laval, Québec, Québec.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bois
authors.affiliation: Département de médecine sociale et préventive, Université Laval, Québec, Québec.
authors.forename: Léon
authors.initials: L
authors.lastname: Nshimyumukiza
authors.affiliation: Centre de recherche, CHUL, CHUQ, Québec, Québec; Département de pédiatrie, Laval, Québec, Québec.
authors.forename: Jean
authors.initials: J
authors.lastname: Gekas
authors.affiliation: Centre de recherche, CHUL, CHUQ, Québec, Québec; Département de pédiatrie, Laval, Québec, Québec; Département d'obstétrique et gynécologie, Université Laval, Québec, Québec.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.affiliation: Centre de recherche, CHUL, CHUQ, Québec, Québec.
authors.forename: Valérie
authors.initials: V
authors.lastname: Morin
authors.affiliation: Institut de santé publique du Québec (INSPQ), Montréal, Québec.
authors.forename: Maud
authors.initials: M
authors.lastname: Vallée
authors.affiliation: Département de biologie moléculaire, biochimie médicale et pathologie, Université Laval, Québec, Québec; Centre de recherche, Hopital St-François d'Assise, CHUQ, Québec, Québec.
authors.forename: Yves
authors.initials: Y
authors.lastname: Giguère
authors.affiliation: Département de génie électrique et génie informatique, Université Laval, Québec, Québec.
authors.forename: Christian
authors.initials: C
authors.lastname: Gagné
authors.affiliation: Département de biologie moléculaire, biochimie médicale et pathologie, Université Laval, Québec, Québec; Centre de recherche, Hopital St-François d'Assise, CHUQ, Québec, Québec.
authors.forename: François
authors.initials: F
authors.lastname: Rousseau
authors.affiliation: Département de médecine sociale et préventive, Université Laval, Québec, Québec.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005220:Fathers; D005260:Female; D005333:Fetus / Q000276:immunology; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D017146:Models, Organizational; D011247:Pregnancy; D011314:Preventive Health Services / Q000191:economics / Q000379:methods; D011792:Quebec; D012203:Rh Isoimmunization / Q000235:genetics / Q000517:prevention & control*; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*
chemical_list: D007155:Immunologic Factors; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
keywords: Rhesus; alloimmunization; cost-effectiveness; genotyping; hemolytic disease; simulation