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The economics of routine antenatal anti‐D prophylaxis for pregnant women who are rhesus negative
Author(s) -
Chilcott Jim,
Tappenden Paul,
Lloyd Jones Myfanwy,
Wight Jeremy,
Forman Katie,
Wray Julie,
Beverley Catherine
Publication year - 2004
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00226.x
Subject(s) - medicine , population , pregnancy , pediatrics , cost effectiveness , cost effectiveness analysis , nice , obstetrics , intervention (counseling) , cost–benefit analysis , psychiatry , environmental health , ecology , risk analysis (engineering) , genetics , computer science , biology , programming language
Objective To investigate the economics of routine antenatal anti‐D prophylaxis in the prevention of haemolytic disease of the newborn, in support of the NICE appraisals process. Design Cost effectiveness analysis. Setting UK NHS. Population/Sample Pregnant women who are RhD‐negative. Methods A model was constructed to estimate the incremental cost effectiveness and cost utility of: (1) offering routine antenatal anti‐D prophylaxis to all pregnant women who are RhD‐negative; (2) offering routine antenatal anti‐D prophylaxis to RhD‐negative primigravidae, compared with conventional management alone. Effectiveness estimates were derived from a meta‐analysis of two UK community‐based studies. Costs were derived from published sources and NHS product lists. Threshold analysis was conducted to reflect the social value of routine antenatal anti‐D prophylaxis through incorporating valuations of parental grief and fetal/neonatal loss. Main outcome measures Cost per life year gained and cost per quality adjusted life year (QALY) gained. Results The cost per life year gained is in the range £5,000–£15,000. The inclusion of long term neurodevelopmental problems results in a cost utility ranging between £11,000 and £52,000 per QALY gained. Threshold analysis suggests that if fetal loss, parental grief and subsequent high intervention pregnancy are valued at greater than 9 QALYs, the comprehensive policy would be more attractive than the primigravidae policy, assuming a maximum acceptable threshold of £30,000 per QALY. Conclusion Routine antenatal anti‐D prophylaxis provides a cost effective intervention for preventing haemolytic disease of the newborn in the pregnancies of women who are RhD‐negative.