Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Contraception. 2024 Aug;136:110468. doi: 10.1016/j.contraception.2024.110468. Epub 2024 Apr 20.
To estimate the cost of Rhesus (Rh) testing and prophylaxis for first-trimester vaginal bleeding in the ambulatory setting.
We used time-driven, activity-based costing to analyze tasks associated with Rh testing and prophylaxis of first-trimester vaginal bleeding at one hospital-based outpatient and two independent reproductive health clinics. At each site, we observed 10 patients undergoing Rh-typing and two patients undergoing Rh prophylaxis. We computed the costs of blood Rh-typing by both fingerstick and phlebotomy, cost of locating previous blood type in the electronic health record (available for 69.8% of hospital-based patients), and costs associated with Rh immune globulin prophylaxis. All costs are reported in 2021 US dollars.
The hospital-based clinic reviewed the electronic health record to confirm Rh-status (cost, $26.18 per patient) and performed a phlebotomy, at $47.11 per patient, if none was recorded. The independent clinics typed blood by fingerstick, at a per-patient cost of $4.07. Rh-immune globulin administration costs, including the medication, were similar across facilities, at a mean of $145.66 per patient. Projected yearly costs for testing and prophylaxis were $55,831 for the hospital-based clinic, which was the lowest-volume site, $47,941 for Clinic A, which saw 150 patients/month, and $185,654 for Clinic B, which saw 600 patients/month.
Rh testing and prophylaxis for first-trimester vaginal bleeding generates considerable costs for outpatient facilities, even for Rh-positive patients with a prior blood type on record.
Rh testing and prophylaxis for first-trimester bleeding generate considerable costs even for Rh-positive patients and those with a previously known blood type. These findings highlight the need to reconsider this practice, which is no longer supported by evidence and already safely waived in multiple medical settings in the United States and around the world.
估算在门诊环境下对第一孕期阴道出血进行 Rh 检测和预防的成本。
我们使用基于时间的、基于活动的成本核算方法，分析了一家医院门诊和两家独立的生殖健康诊所中与 Rh 检测和第一孕期阴道出血预防相关的任务。在每个地点，我们观察了 10 名接受 Rh 定型和 2 名接受 Rh 预防的患者。我们通过手指穿刺和静脉采血计算了血液 Rh 定型的成本，计算了在电子健康记录中查找先前血型的成本（对于 69.8%的医院患者可用），以及 Rh 免疫球蛋白预防相关的成本。所有成本均以 2021 年美元报告。
医院诊所通过查看电子健康记录来确认 Rh 状态（每位患者成本为 26.18 美元），如果没有记录，则进行静脉采血，每位患者成本为 47.11 美元。独立诊所通过手指穿刺进行血型鉴定，每位患者的成本为 4.07 美元。在各个设施中，Rh 免疫球蛋白给药成本包括药物在内，每位患者的费用相似，为 145.66 美元。医院诊所的检测和预防的年度费用预计为 55831 美元，这是患者数量最少的诊所；A 诊所每月接待 150 名患者，费用为 47941 美元；B 诊所每月接待 600 名患者，费用为 185654 美元。
即使对于 Rh 阳性患者和有先前记录的血型患者，门诊设施也需要为第一孕期阴道出血的 Rh 检测和预防支付大量费用。
即使对于 Rh 阳性患者和有先前已知血型的患者，Rh 检测和预防第一孕期出血也会产生大量费用。这些发现强调了需要重新考虑这种做法的必要性，这种做法在美国和世界各地的多个医疗环境中已经不再得到证据支持，并且已经安全豁免。
