title: Cost-effectiveness of first trimester non-invasive fetal RHD screening for targeted antenatal anti-D prophylaxis in RhD-negative pregnant women: a model-based analysis.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of first trimester non-invasive fetal RHD screening for targeted antenatal versus no routine antenatal anti-D prophylaxis (RAADP) or versus non-targeted RAADP.
  
  
  METHODS
  Model based on a population-based cohort study.
  
  
  METHODS
  The Swedish health service.
  
  
  METHODS
  Intervention subjects in the underlying cohort study were RhD-negative pregnant women receiving first trimester fetal RHD screening followed by targeted anti-D in 2010-2011 (n = 6723). Historical comparators were RhD-negative women who delivered in 2008-2009 when standard care did not include RAADP (n = 7099).
  
  
  METHODS
  Healthcare costs for the three strategies were included for the first and subsequent pregnancies. For the comparison with non-targeted RAADP, the immunisation rate was based on the observed rate for targeted therapy and adjusted downwards by removing the influence of false negatives.
  
  
  METHODS
  Additional cost per RhD immunisation averted.
  
  
  RESULTS
  Compared with RAADP, targeted prophylaxis was associated with fewer immunisations (0.19 versus 0.46% per pregnancy) and lower costs (cost-savings of €32 per RhD-negative woman). The savings were from lower costs during pregnancy and delivery, and lower costs of future pregnancies through fewer immunisations. Non-targeted anti-D was estimated to result in 0.06% fewer immunisations and an additional €16 in cost-savings per mother, compared with targeted anti-D.
  
  
  CONCLUSIONS
  Based on effect data from a population-based cohort study, targeted prophylaxis was associated with lower immunisation risk and costs versus no RAADP. Based on effect data from theoretical calculations, non-targeted RAADP was predicted to result in lower costs and immunisation risk compared with targeted prophylaxis.
  
  
  CONCLUSIONS
  Fetal RHD screening and targeted prophylaxis resulted in lower immunisation risk and costs compared with no RAADP.
authors.affiliation: Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Neovius
authors.affiliation: Obstetrics & Gynaecology Unit, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Tiblad
authors.affiliation: Obstetrics & Gynaecology Unit, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Westgren
authors.affiliation: Obstetrics & Gynaecology Unit, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Kublickas
authors.affiliation: Aux Analysis AB, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Neovius
authors.affiliation: Department of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wikman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004899:Erythroblastosis, Fetal / Q000517:prevention & control*; D005260:Female; D006296:Health Services / Q000191:economics; D006403:Hematologic Tests / Q000191:economics; D006801:Humans; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000191:economics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012203:Rh Isoimmunization / Q000517:prevention & control*; D018029:Rho(D) Immune Globulin / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D013548:Sweden
chemical_list: D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin
keywords: Cost-effectiveness; Rhesus D immunisation; fetal screening