Screening of pregnant women for fetal neonatal alloimmune
thrombocytopenia: a cost-utility analysis
Abstract
Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT)
results from maternal platelet-directed antibodies which can cause
severe intracranial haemorrhage (ICH) in fetuses and new-borns.
Screening for human platelet antigen-1a (HPA-1a) directed antibodies
during pregnancy could allow for timely intervention with antenatal
treatment and prevent the occurrence of ICH. We aim to assess the
cost-effectiveness of adding screening for anti-HPA-1a to the prenatal
screening program. Design: A decision analysis model was developed.
Setting: The Netherlands. Population: 171,713 pregnant women. Methods:
Lifetime costs and effects of antenatal anti-HPA-1a screening with
subsequent diagnostic and treatment interventions were compared to the
current situation without screening in the Netherlands. Model parameters
were based on literature and expert opinions. One-way-sensitivity
analysis and probabilistic sensitivity analysis were performed. Main
Outcome Measures: Incremental cost-effectiveness ratio (ICER). Results:
Adding screening for HPA-1a antibodies to the current antenatal
screening program of the Netherlands will lead to an additional cost of
4.7 million euro and a gain of 226 Quality-Adjusted Life Years (QALY)
per year, indicating an ICER of \euro20,782 per QALY gained. One-way
sensitivity analysis showed that the uncertainty around the incidence of
ICH, lifetime costs of disabled children and the probability of having
antibody quantitation >3.0 IU/ml at 20 weeks had the
highest effect on the ICER. Conclusion: Antenatal HPA-1a screening might
be cost-effective. To obtain more knowledge and thereby reduce the
uncertainty on risk stratification, a pilot screening program is
warranted. Funding: Sanquin