Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

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Abstract:

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.

Keywords: Cost-effectiveness; HPA 1a; NAIT; screening

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2007.01289.x

Affiliations: Institute of Community Medicine, University of Tromsø, Tromsø, Norway

Publication date: May 1, 2007

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