Cost‐effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

Abstract

Objectives To estimate the costs and health consequences of three different screening strategies for neonatal alloimmune thrombocytopenia (NAIT).Design Cost-utility analysis on the basis of a decision tree that incorporates the relevant strategies and outcomes.Setting Three health regions in Norway encompassing a 2.78 million population.Population Pregnant women (n = 100,448) screened for human platelet antigen (HPA) 1a and anti-HPA 1a antibodies, and their babies.Method Decision tree analysis. In three branches of the decision tree, pregnant women entered a programme while in one no screening was performed. The three different screening strategies included all HPA 1a negative women, only HPA 1a negative, HLA DRB3*0101 positive women or only HPA 1a negative women with high level of anti-HPA 1a antibodies. Included women underwent ultrasound examination and elective caesarean section 2-4 weeks before term. Severely thrombocytopenic newborn were transfused immediately with compatible platelets.Main outcome measurements Quality-adjusted life years (QALYs) and costs.Results Compared with no screening, a programme of screening and subsequent treatment would generate between 210 and 230 additional QALYs among 100 000 pregnant women, and at the same time, reduce health care costs by approximately e1.7 million. The sensitivity analyses indicate that screening is cost effective or even cost saving within a wide range of probabilities and costs.Conclusion Our calculations indicate that it is possible to establish an antenatal screening programme for NAIT that is cost effective.

A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia

“…37 However, there are increased costs associated with elective CS compared with planned vaginal delivery and we have calculated the average costs per CS, including possible additional costs associated with treatment of neonates with pulmonary maladaption, to be approximately US $4800. 38 This calculation is part of a comprehensive cost-effectiveness analysis where we show that the screening and intervention program applied to a population of 100 000 pregnant women would save 210 to 230 qualityadjusted life years and, at the same time, reduce health care costs by approximately US $2.2 million. 38 An important weakness of the present study is the absence of a control group consisting of planned vaginal deliveries.…”

“…38 This calculation is part of a comprehensive cost-effectiveness analysis where we show that the screening and intervention program applied to a population of 100 000 pregnant women would save 210 to 230 qualityadjusted life years and, at the same time, reduce health care costs by approximately US $2.2 million. 38 An important weakness of the present study is the absence of a control group consisting of planned vaginal deliveries. If we had conducted an RCT, the GPs should have been willing and able to explain to the pregnant women the implications of being included in the trial and the consequences of being randomized to one or the other study arm.…”

Incidence and Consequences of Neonatal Alloimmune Thrombocytopenia: A Systematic Review

“…Several groups have published calculations of costs and potential benefits of screening and intervention, all coming to the same conclusion that such programs are likely cost-effective. [5][6][7][20][21][22] The main reason for cost-effectiveness, despite large-scale testing and, in the case of IVIG, expensive treatment, is the fact that the disease burden and costs for a child with lifelong severe neurologic damage from ICH is excessive.…”

Reconsidering fetal and neonatal alloimmune thrombocytopenia with a focus on screening and prevention

“…Current research in the field is hopeful of a solution to these questions [11,21]. A large prospective screening and intervention study carried out in Norway from 1995 to 2004, including 154 HPA-1a-immunized women in 170 pregnancies, indicated that it is possible to reduce the risk for morbidity and mortality associated with FNAIT [3].…”

“…Other genetic and phenotypic markers are being studied to define the population more accurately. There are strong indications that a screening program would be clinically efficient [3], and also cost effective [21]. This evidence could be created as a result of a randomized study but this is considered unethical to perform.…”