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

Abstract

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High-throughput non-invasive prenatal testing for fetal rhesus D status in RhD-negative women not known to be sensitised to the RhD antigen: a systematic review and economic evaluation

“…he has one RhD-positive gene and one RhD-negative gene) his children will have a 50% chance of being RhD-negative. Therefore, as in the NICE TA156, 62 the model assumes that the proportion of RhD-positive babies born to RhD-negative women is a function of (1) the proportion of RhD-positive men (assumed to be identical to the proportion of RhD-positive women, thus, the complement of the proportion of RhD-negative women), (2) the proportion of heterozygous fathers and (3) the proportion of heterozygous fathers having RhD-positive babies. Although the probability of having a RhD-positive baby in subsequent pregnancies can be estimated conditional on knowledge of the RhD status of the first baby, we do not split the cohort in this way.…”

“…62 No new systematic reviews of RAADP with studies not considered in TA156 were identified. We maintain consistency between the NICE TA process and the diagnostics assessment of high-throughput NIPT for fetal rhesus D status by utilising the RAADP …”

“…The conceptualisation and development of the de novo model was informed by existing economic modelling studies described in Chapter 4, Methodology of the cost-effectiveness review and the independent economic model used to inform NICE technology appraisal (TA)156 on the clinical and cost-effectiveness of RAADP. 62 The model provides a framework for the synthesis of diagnostic accuracy reported in Chapter 3 with a range of other relevant parameters required to establish cost-effectiveness.…”

“…To inform other parameter estimates for this simulation, we conducted an additional literature search to identify relevant systematic reviews of antenatal anti-D prophylaxis. Four relevant reviews [61][62][63][64] were identified. These reviews provided data on the probability estimates of the events used in the simulation study, including sensitisation and compliance rates.…”

“…The model was made up of two main elements: (1) an identification part reflecting the diagnostic performance and costs of the alternative identification strategies and (2) 62 This model was kindly provided on request and was subsequently modified and updated to accommodate all the required changes for the cost-effectiveness assessment of the introduction of high-throughput NIPT in pregnant RhD-negative women's clinical pathway, as outlined in Appendix 10.…”