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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Article info
Publication history
Published online: August 11, 2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
