Routine Anti-D Ig Prophylaxis More Cost-Effective Than Fetal RhD Typing

August 21, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 21 - Routine anti-D immune globulin prophylaxis in RhD-negative women is more cost-effective than noninvasive fetal RhD typing and targeted prophylaxis, according to a decision tree analysis.

Noninvasive fetal RhD typing examines fetal RhD genes in maternal plasma and appears to be very accurate for identifying Rh-negative fetuses.

But "although the technology is great and something we should utilize, until it is more affordable, it doesn't seem to make sense to use it in the general population of non-alloimmunized, RhD-negative women," Dr. Angela F. Hawk from Medical University of South Carolina in Charleston told Reuters Health.

Dr. Hawk and colleagues used a decision tree analysis to examine the costs and benefits of noninvasive RhD genotyping. They compared three strategies: routine antenatal anti-D immune globulin prophylaxis and postpartum prophylaxis guided by cord blood typing; noninvasive fetal RhD typing with prophylaxis guided by test results; and no screening or prophylaxis.

The cost per pregnancy for the first strategy (routine anti-D immune globulin prophylaxis) is $351, whereas the cost for the noninvasive fetal RhD typing (including the cost of the test and the management of possible sensitization) would be $682 per pregnancy.

For the costs of the two strategies to be equal, the cost of fetal RhD typing would have to decrease from $450 to $119, or the cost of anti-D immune globulin would have to increase from $172 to $825, according to a report in the September issue of Obstetrics & Gynecology, online now.

On the other hand, the use of noninvasive testing could avoid 500,000 unnecessary administrations of anti-D immune globulin per 1 million pregnancies, for a savings of $85 million in anti-D immune globulin expense.

"This technology exists and it has an appropriate and important place in the management of RhD sensitized pregnancies," Dr. Hawk explained. "Many physicians might not be aware that there is a noninvasive option for fetal RhD assessment that does not require any paternal testing."

"I think it is also important to highlight that the newest technology isn't always the 'best option' and that it must be examined on a global level to see how to best incorporate its use into the health care system," Dr. Hawk said.

"It makes sense to use this in almost any sensitized pregnancy where paternal assessment is being considered, given the high possibility of nonpaternity even in reportedly monogamous relationships," Dr. Hawk said. "Individual circumstances should also be taken into account. As I mentioned in the article, this is a great option for those women who are opposed to the use of any blood-derived products."

"Finally," Dr. Hawk added, "if the supply of anti-D immune globulin wanes or the price of this product rises for any reason, noninvasive fetal assessment would be a good option."

SOURCE: http://bit.ly/16dogy2

Obstet Gynecol 2013;122:579-585.

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