Centre for Health Economics, University of York, York, UK.
Medical School, University of Exeter, Exeter, UK.
BJOG. 2018 Oct;125(11):1414-1422. doi: 10.1111/1471-0528.15152. Epub 2018 Mar 15.
To evaluate the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal Rhesus D (RhD) genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared with routine antenatal anti-D immunoglobulin prophylaxis (RAADP).
Cost-effectiveness decision-analytic modelling.
Primary care.
A simulated population of 100 000 RhD-negative women not known to be sensitised to the RhD antigen.
A decision tree model was used to characterise the antenatal care pathway in England and the long-term consequences of sensitisation events. The diagnostic accuracy of HT-NIPT was derived from a systematic review and bivariate meta-analysis; estimates of other inputs were derived from relevant literature sources and databases. Women in whom the HT-NIPT was positive or inconclusive continued to receive RAADP, whereas women with a negative result received none. Five alternative strategies in which the use of HT-NIPT may affect the existing postpartum care pathway were considered.
Costs expressed in 2015GBP and impact on health outcomes expressed in terms of quality-adjusted life-years over a lifetime.
The results suggested that HT-NIPT appears cost saving but also less effective than current practice, irrespective of the postpartum strategy evaluated. A postpartum strategy in which inconclusive test results are distinguished from positive results performed best. HT-NIPT is only cost-effective when the overall test cost is £26.60 or less.
HT-NIPT would reduce unnecessary treatment with routine anti-D immunoglobulin and is cost saving when compared with current practice. The extent of any savings and cost-effectiveness is sensitive to the overall test cost.
HT-NIPT is cost saving compared with providing anti-D to all RhD-negative pregnant women.
评估高通量、非侵入性产前检测（HT-NIPT）用于胎儿 RhD（RhD）基因型检测，以指导抗 D 免疫球蛋白用于产前预防，与常规产前抗 D 免疫球蛋白预防（RAADP）相比，评估其成本效益。
成本效益决策分析模型。
初级保健。
100000 名 RhD 阴性且未致敏于 RhD 抗原的模拟人群。
使用决策树模型描述英格兰的产前保健路径和致敏事件的长期后果。HT-NIPT 的诊断准确性来自系统评价和双变量荟萃分析；其他投入的估计值来自相关文献来源和数据库。HT-NIPT 阳性或不确定的女性继续接受 RAADP，而 HT-NIPT 阴性的女性则不接受任何治疗。考虑了五种可能影响现有产后护理路径的 HT-NIPT 使用替代策略。
以 2015 年英镑表示的成本和以终身质量调整生命年表示的健康结果的影响。
无论评估的产后策略如何，结果均表明 HT-NIPT 似乎具有成本效益，但效果不如现行做法。将不确定的测试结果与阳性结果区分开来的产后策略效果最好。只有当总测试成本为 26.60 英镑或以下时，HT-NIPT 才具有成本效益。
与现行做法相比，HT-NIPT 可减少不必要的常规抗 D 免疫球蛋白治疗，且具有成本效益。任何节省和成本效益的程度都取决于总体测试成本。
与为所有 RhD 阴性孕妇提供抗 D 相比，HT-NIPT 具有成本效益。
