Routine antenatal anti-D prophylaxis for RhD-negative women: a systematic review and economic evaluation

Area of Science:

• Immunology
• Obstetrics
• Health Economics

Background:

• Rhesus D (RhD) incompatibility between mother and fetus can lead to haemolytic disease of the newborn.
• Routine antenatal anti-D prophylaxis (RAADP) is a strategy to prevent RhD sensitisation in RhD-negative women.
• The clinical effectiveness and cost-effectiveness of RAADP require ongoing assessment.

Purpose of the Study:

• To evaluate advances in RAADP since the 2002 NICE appraisal.
• To assess the current clinical effectiveness of RAADP for RhD-negative women.
• To determine the cost-effectiveness of RAADP for RhD-negative women.

Main Methods:

• Bibliographic databases were searched from inception to July 2007.
• Included studies were assessed for quality, and data extracted.
• A modified health economic model was used to assess cost-effectiveness.

Main Results:

• Clinical effectiveness studies were generally of poor quality, with limited new data.
• RAADP may reduce the sensitisation rate from 0.95% to 0.35%, an absolute risk reduction of 0.6%.
• The cost per QALY gained for RAADP in primigravidae is £9,000-£15,000; for all RhD-negative women, it is £20,000-£35,000.

Conclusions:

• RAADP effectively reduces RhD sensitisation and haemolytic disease of the newborn.
• RAADP for all RhD-negative pregnant women is likely cost-effective at a threshold of £30,000 per QALY.
• Annual costs for RAADP in England and Wales are estimated at £1.8-£3.5 million.