Screening Primiparous Women and Newborns for Fetal/Neonatal Alloimmune Thrombocytopenia: A Prospective Comparison of Effectiveness and Costs

ABSTRACT

A prospective study was conducted in three maternity wards to compare the medical outcomes and the costs of two screening strategies for the detection of fetal/neonatal alloimmune thrombocytopenia (FMAIT). A total of 2066 primiparas and 6081 newborns were included. Fifty-two primiparous women with HPA-1b phenotype were found, and 45 were followed during pregnancy. Four women developed antibodies, and two fetuses exhibited FMAIT; therefore, the prevalence of anti-HPA-1a was 2 per 1000, and the prevalence of FMAIT 1 per 1000. Forty-eight thrombocytopenic newborns were found out of a total of 5632 blood samples. Five were HPA-1a children whose mothers were HPA-1b. The cost-effectiveness of screening all primiparous women was $45,000 and of screening all newborns is $18,000 per anti-HPA-1a alloimmunization diagnosed. Costs per fetal death or disability averted were $500,000 for the primiparous strategy and $225,000 for the newborn strategy. In conclusion, screening newborns for neonatal alloimmune thrombocytopenia is more cost-effective than screening primiparous women.

Keywords

Neonatal alloimmune thrombocytopenia - cost-effectiveness analysis - fetal diagnosis - screening - economics

7 Y Aujard, C Baumann, P Blot, C Boissinot, F Daffos, H Fernandez, F Forestier, F Hurtaud-Roux, JF Oury, JC Pons, G Tchernia, E Verdy. From: Hôpital Robert Debré, Hôpital de Bicêtre, Hôpital Antoine Béclère, Institut de Puériculture, Hôpital Tenon.