The use of antenatal anti–human platelet antigen-1a (HPA-1a) screening for fetal and neonatal alloimmune thrombocytopenia (FNAIT) has shown to be cost-effective within the European health care system, according to findings from a cost-utility analysis published recently in Vox Sanguinis.
Screening for HPA-1a–directed antibodies during pregnancy often enables timely intervention with antenatal therapy and prevents the occurrence of intracranial hemorrhage (ICH). Based on this knowledge, the researchers sought to evaluate the cost effectiveness of using HPA-1a typing and anti–HPA-1a screening as part of a prenatal pilot screening program.
FNAIT is recognized as a rare, serious disorder that may lead to ICH, as well as organ bleeding, among fetuses and newborns. In FNAIT, maternal immunoglobulin G antibodies are directed against paternally inherited antigens that are located on fetal platelets.
Among the patient population recognized to be of European ancestry, most of the FNAIT cases reported are caused by antibodies against HPA-1a.
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The researchers designed a decision analysis model in which they compared the lifetime costs and effects linked to antenatal HPA-1a screening with the scenario in which screening is not utilized. Costs associated with the use of tests and treatments in The Netherlands were the gauge.
They tested a number of different HPA-1a screening situations. The model included the utilization of fetal HPA-1a typing in order to confirm fetal-maternal incompatibility.
Based on the fact that the proposed program will affect both the life expectancy and the quality of life of children with FNAIT, the outcome of the study was expressed in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) used in the study was conveyed in terms of incremental cost per QALY.
Results of the study showed that when the screening for anti–HPA-1a antibodies was added to the existing antenatal screening program currently used in The Netherlands, an additional cost of €4.7 million per year and a gain of 226 QALYs per year were incurred. This was indicative of an ICER of €20,782 per QALY gained.
Findings from one-way sensitivity analysis revealed that the uncertainty surrounding the incidence of ICH, the lifetime costs associated with having a disabled child and the probability of having antibody quantitation of more than 3.0 IU/mL at 20 weeks all exhibited the greatest impact on ICER.
“Antenatal anti–HPA-1a screening might be cost effective,” the authors wrote. “To obtain more knowledge and thereby to improve risk stratification, a pilot screening [program] is recommended.”
