Article Text

Can non-invasive prenatal determination of fetal RhD status be cost effective?
  1. LS Chitty1,2,
  2. K Finning3,
  3. E Massey3,
  4. J Harris2,
  5. G Daniels3,
  6. C Phillips4
  1. 1Clinical Molecular Genetics Unit, UCL Institute of Child Health, UCLH, London, UK
  2. 2Fetal Medicine Unit, Institute for Women's Health, UCLH, London, UK
  3. 3International Blood Group Reference Laboratory, NHS Blood and Transport, London, UK
  4. 4Health Science, Swansea University, Swansea, UK

Abstract

Background Non-invasive prenatal determination (NIPD) of fetal RhD status in D− mothers is reliable at 28-week gestation. RhD− mothers carrying D− fetuses are not at risk of sensitisation, thus NIPD used routinely has potential to reduce use of anti-D with potential savings to the National Health Service (NHS) and families.

Objective To ascertain usage of anti-D and estimate potential savings assuming NIPD was accurate at various gestations.

Methods Doses of anti-D used over 10 months were ascertained, gestation and indication for administration determined, projected doses saved assuming NIPD is reliable at various gestations estimated and potential cost savings identified with NIPD given at 28 weeks so as to offset the cost of fetal RhD status testing.

Results 809 doses were dispensed – indications and gestation used are known in 803. The table shows details of gestational ages of anti-D administration with potential doses saved. A more detailed cost analysis will be described to include other NHS costs.

Conclusion Based on doses of anti-D avoided, NIPD delivered earlier represents potential savings. The extent of this depends on the cost of fetal genotyping, with overall savings achieved if NIPD was reliable at 12 weeks and fetal genotyping costs less than £10.50.

Gestation fetal D status known (weeks)122028*
Cumulative current anti-D usage before these times20105531
Potential doses saved compared with 28 weeks43100
Potential savings per woman if NIPD accurate <28 weeks£38£360
  • * Would require additional hospital contact for 60% D− women.

  • Statistics from Altmetric.com

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