Is HT-NIPT cost-effective for guiding postpartum use of anti-D?
A simulation by British investigators shows that high-throughput, noninvasive prenatal testing (HT-NIPT) for fetal Rhesus D (RhD) may help save costs by reducing unnecessary treatment with routine anti-D immunoglobulin. The extent of the savings depends on the overall test cost.
Published in BJOG, the findings are based on use of a decision-tree model to simulate a population of 100,000 RhD-negative women not known to be sensitized to the RhD antigen. The model was used to characterize the antenatal care pathway in England and long-term consequences of sensitization events.
The authors derived the diagnostic accuracy of HT-NIPT from a systematic review and bivariate meta-analysis. Relevant literature sources and databases were used to estimate other inputs. Women in whom HT-NIPT was positive or inconclusive continued to receive routine anti-D immunoglobulin prophylaxis (RAADP); those with a negative HT-NIPT did not receive RAADP.
Five alternative strategies in which use of HT-NIPT might affect the existing postpartum care were considered by the researchers. Costs were in 2015 British Pounds Sterling and impact on health outcomes was expressed in terms of quality-adjusted life-years over a lifetime.
The simulation suggested that HT-NIPT saved costs but was also less effective than current practice, irrespective of the postpartum strategy the authors evaluated. The best performance was with a postpartum strategy in which inconclusive tests results were distinguished from positive results. HT-NIPT was only cost-effective if the overall test cost was no more than £26.60 (approximately $36.96).