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Cost-Effectiveness of the Management of Rh-Negative Pregnant Women


Julie Duplantie, Odilon Martinez Gonzalez, Antoine Bois, Léon Nshimyumukiza, Jean Gekas, Emmanuel Bujold, Valérie Morin, Maud Vallée, Yves Giguère, Christian Gagné, François Rousseau and Daniel Reinharz

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Abstract -

Objective: The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor.

Methods: A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father’s Rh type; (4) mixed screening: immunological determination of the father’s Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants.

Results: In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option.

Conclusion: Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.

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Bibtex:

@article{Giguère984,
    author    = { Julie Duplantie and Odilon Martinez Gonzalez and Antoine Bois and Léon Nshimyumukiza and Jean Gekas and Emmanuel Bujold and Valérie Morin and Maud Vallée and Yves Giguère and Christian Gagné and François Rousseau and Daniel Reinharz },
    title     = { Cost-Effectiveness of the Management of Rh-Negative Pregnant Women },
    volume    = { 35 },
    number    = { 8 },
    pages     = { 730-740 },
    year      = { 2013 },
    month     = { 8 },
    journal   = { Journal of Obstetrics and Gyneacology of Canada },
    web       = { http://www.jogc.com/abstracts/full/201308_HealthPolicy_1.pdf }
}

Dernière modification: Sep 5 2013 12:01PM par cgagne

     
   
   

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