Screening of pregnant women for foetal neonatal alloimmune thrombocytopenia: A cost–utility analysis

Abstract

Background and Objectives: Foetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies and can result in severe intracranial haemorrhage (ICH) in foetuses and newborns. Screening for human platelet antigen-1a (HPA-1a)-directed antibodies during pregnancy could allow timely intervention with antenatal treatment and prevent ICH. We assessed the cost effectiveness of HPA-1a typing and anti-HPA-1a-screening as part of the prenatal screening programme. Materials and Methods: Different HPA-1a screening scenarios were tested in a decision analysis model and assessed for diagnostic, treatment, intervention and lifetime costs and prevention effects compared to the current situation without screening in the Netherlands. Model parameters were based on available data, literature and expert opinions. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: Adding screening for anti-HPA-1a antibodies to the current antenatal screening programme of the Netherlands will lead to an additional cost of €4.7 million per year and a gain of 226 quality-adjusted life years (QALYs) per year, indicating an incremental cost–effectiveness ratio (ICER) of €20,782 per QALY gained. One-way sensitivity analysis showed that the uncertainty around the incidence of ICH, lifetime costs of disabled children and the probability of having antibody quantitation >3.0 IU/mL at 20 weeks had the highest effect on the ICER. Conclusion: Antenatal anti-HPA-1a screening might be cost effective. To obtain more knowledge and thereby to improve risk stratification, a pilot screening programme is warranted.