Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia.

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 euros. 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.