Cost‐effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

• Published in: BJOG : an international journal of obstetrics and gynaecology 2007-05, Vol.114 (5), p.588-595
• Main Authors: Killie, MK, Kjeldsen‐Kragh, J, Husebekk, A, Skogen, B, Olsen, JA, Kristiansen, IS
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood diseases; Comparative studies; Cost analysis; Cost-Benefit Analysis; Cost‐effectiveness; Diagnostic tests; Female; Gynecology. Andrology. Obstetrics; Health Status; Hematologic and hematopoietic diseases; HPA 1a; Humans; Infant, Newborn; Life Expectancy; Medical sciences; Medical screening; NAIT; Norway - epidemiology; Obstetrics; Platelet diseases and coagulopathies; Pregnancy; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - economics; Prenatal development; Prenatal Diagnosis - economics; Purpura, Thrombocytopenic, Idiopathic - diagnosis; Purpura, Thrombocytopenic, Idiopathic - economics; Quality of Life; Quality-Adjusted Life Years; screening
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2007.01289.x

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 €1.7 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.