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Noninvasive Fetal RhD Blood Group Genotyping: A Systematic Review of Economic Evaluations

Published:August 11, 2021DOI:https://doi.org/10.1016/j.jogc.2021.07.014

      ABSTRACT

      Objective

      Noninvasive fetal rhesus D (RhD) blood group genotyping may prevent unnecessary use of anti-D immunoglobulin (RhIG) in non-alloimmunized RhD-negative pregnancies and can guide management of alloimmunized pregnancies. We conducted a systematic review of the economic literature to determine the cost-effectiveness of this intervention over usual care.

      Data Sources

      Systematic literature searches of bibliographic databases (Ovid MEDLINE, Embase, and Cochrane) until February 26, 2019, and auto-alerts until October 30, 2020, and of grey literature sources were performed to retrieve all English-language studies.

      Study Selection

      We included studies done in serologically confirmed non-alloimmunized or alloimmunized RhD-negative pregnancies, comparing costs and effectiveness of the intervention versus usual care.

      Data Extraction and Synthesis

      Two reviewers extracted data from the eligible studies and assessed their methodological quality (risk of bias) using the Quality of Health Economic Studies (QHES) and Drummond tools. We narratively synthesized findings. Our review included 8 economic studies that evaluated non-invasive fetal RhD genotyping followed by targeted RhIG prophylaxis in non-alloimmunized pregnancies. Five studies further considered a subsequent alloimmunized pregnancy. The cost-effectiveness of the intervention versus usual care (e.g., universal RhIG or prophylaxis conditional on results of paternal testing) for non-alloiummunized pregnancies was inconsistent. Two studies indicated greater benefits and lower costs for the intervention, and another 2 suggested a trade-off. In 4 studies, the intervention was less effective and costlier than alternatives. Three studies were determined to be of high quality by both tools. Two of these studies favoured the intervention, and one assessed benefits in quality-adjusted life-years. No study clearly examined the cost-effectiveness of repetitive use of fetal genotyping in multiple non-alloimmunized or alloimmunized pregnancies. The cost of genotyping was the most influential parameter.

      Conclusion

      The cost-effectiveness of noninvasive fetal RhD genotyping for non-alloimmunized pregnancies varies between studies. Potential savings from targeted management of alloimmunized pregnancies requires further research.

      RÉSUMÉ

      Objectif

      Le génotypage non invasif du rhésus D (RhD) fœtal peut prévenir l'administration inutile d'immunoglobulines anti-D (IgRh) en cas de grossesses non allo-immunisées RhD négatif et guider la prise en charge des grossesses allo-immunisées. Nous avons effectué une revue systématique de la littérature économique pour déterminer le rapport coût-efficacité de cette intervention par rapport aux soins habituels.

      Sources de données

      Des recherches documentaires systématiques ont été effectuées dans les bases de données bibliographiques (Ovid MEDLINE, Embase et Cochrane) jusqu'au 26 février 2019, avec des alertes automatiques jusqu'au 30 octobre 2020, et dans les sources de littérature grise afin d'en extraire toutes les études publiées en anglais.

      Sélection des études

      Nous avons inclus des études réalisées auprès de femmes enceintes allo-immunisées ou non allo-immunisées RhD négatif avec confirmation sérologique pour comparer les coûts et l'efficacité de l'intervention par rapport aux soins habituels.

      Extraction et synthèse des données

      Deux évaluateurs ont extrait des données des études admissibles et ont évalué leur qualité méthodologique (risque de biais) à l'aide de la grille QHES (Quality of Health Economic Studies) et des méthodes de Drummond. Nous avons synthétisé les résultats sous forme narrative. Notre revue comprend 8 études économiques évaluant le génotypage non invasif du RhD fœtal suivi d'une prophylaxie ciblée par IgRh en cas de grossesses non allo-immunisées. Cinq études se sont également penchées sur une grossesse allo-immunisée subséquente. Les rapports coût-efficacité de l'intervention par rapport aux soins habituels (p. ex., IgRh universel ou prophylaxie conditionnelle aux résultats du génotypage paternel) pour les grossesses non allo-immunisées n’étaient pas uniformes. Deux études ont indiqué des bénéfices supérieurs et des coûts inférieurs pour l'intervention, tandis que deux autres ont suggéré un compromis. Dans quatre études, l'intervention était moins efficace et plus coûteuse que les solutions de rechange. Trois études ont été évaluées comme étant de qualité élevée selon les deux outils. Deux de ces études ont privilégié l'intervention et une a évalué les bénéfices en années de vie pondérées par la qualité. Aucune étude n'a clairement examiné le rapport coût-efficacité de l'utilisation répétée du génotypage fœtal en cas de multiples grossesses allo-immunisées ou non allo-immunisées. Le coût du génotypage était le paramètre ayant la plus grande influence.

      Conclusion

      Le rapport coût-efficacité du génotypage non invasif du RhD fœtal pour les grossesses non allo-immunisées varie d'une étude à l'autre. D'autres études sont nécessaires pour bien évaluer les économies potentielles de la prise en charge ciblée des grossesses allo-immunisées.

      Keywords

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