目的:对美国妊娠<12周时妊娠出血的RhD血型检测和Rh免疫球蛋白(RhIg)给药进行成本分析。
方法:我们创建了一个决策分析模型,比较了目前对有威胁的患者的标准治疗途径。自发的,或者在美国人工流产,对于那些在<12周时RhD阴性的人来说,通过一种新的途径来进行RhD测试和给予RhIg,假设致敏风险为0%。我们从目前的文献中得出了人口和成本估计,并计算了治疗所需的数量,和数量需要筛选,避免一例胎儿和新生儿的致命溶血病。我们进行了敏感性分析,假设Rh致敏风险为1.5%和3%,随后的妊娠率从44-100%变化。
结果:美国医疗保健支付者在<12周时对发生出血事件的RhD阴性患者进行RhD检测和RhIg给药的年度节省为550万美元/100,000总妊娠,假设致敏风险为0%。在敏感性分析中,致敏风险为1.5%,后续妊娠率为84.3%,进行Rh测试和RhIg管理<12周将节省280万美元/100,000怀孕,治疗所需的相应数字为7,322,筛选所需的数字为48,816。在3%的致敏率下,目前的标准治疗途径是最经济的。
结论:通过在特定情况下扣留RhIg并将其保存在怀孕后期使用,有机会为美国医疗保健支付者节省多达550万美元/100,000的怀孕。
结论:如果致敏率<3%,则成本分析支持在妊娠<12周时进行RhD血型筛查和RhIg给药。通过取消这种低价值的护理,在美国,付款人可以节省多达550万美元/100,000的怀孕,并保留RhIg以供怀孕后期使用。
OBJECTIVE: To perform cost analyses of foregoing RhD blood type testing and administration of Rh immunoglobulin (RhIg) for bleeding in pregnancy at <12 weeks gestation in the United States.
METHODS: We created a decision-analytic model comparing the current standard treatment pathway for patients who have threatened, spontaneous, or induced abortion in the United States, with a new pathway foregoing RhD testing and administration of RhIg for those who are RhD-negative at <12 weeks gestation, assuming that the risk of sensitization is 0%. We derived population and cost estimates from the current literature and calculated the number needed to treat (NNT) and number needed to screen to avoid one case of fatal hemolytic disease of the fetus and newborn. We performed sensitivity analyses assuming Rh-sensitization risks of 1.5% and 3% and varying the subsequent pregnancy rates from 44% to 100%.
RESULTS: The annual savings to health care payers in the United States of foregoing RhD testing and RhIg administration with bleeding events at <12 weeks are $5.5 million/100,000 total pregnancies, assuming the sensitization risk is 0%. In sensitivity analyses with a sensitization risk of 1.5% and subsequent pregnancy rate of 84.3% foregoing Rh testing and RhIg administration would save $2.8 million/100,000 pregnancies, with a NNT of 7322 and a number needed to screen of 48,816. At a 3% sensitization rate, the current standard treatment pathway is most economical.
CONCLUSIONS: There is an opportunity to save as much as $5.5 million/100,000 pregnancies by withholding RhIg in specific situations and conserving it for use later in pregnancy.
CONCLUSIONS: Cost analyses support foregoing RhD blood type screening and RhIg administration at <12 weeks gestation if the sensitization rate is <3%. By deimplementing this low-value care, payers in the United States can save as much as $5.5 million/100,000 pregnancies and conserve RhIg for use later in pregnancy.