{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:12:09Z","timestamp":1780467129217,"version":"3.54.1"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T00:00:00Z","timestamp":1521072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the cost\u2010effectiveness of high\u2010throughput, non\u2010invasive prenatal testing (<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>) for fetal\u00a0Rhesus D (RhD) genotype to guide antenatal prophylaxis with anti\u2010D immunoglobulin compared with routine antenatal anti\u2010D immunoglobulin prophylaxis (<jats:styled-content style=\"fixed-case\">RAADP<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cost\u2010effectiveness decision\u2010analytic modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Primary care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A simulated population of 100\u00a0000 RhD\u2010negative women not known to be sensitised to the RhD antigen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision tree model was used to characterise the antenatal care pathway in England and the long\u2010term consequences of sensitisation events. The diagnostic accuracy of<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>was derived from a systematic review and bivariate\u00a0meta\u2010analysis; estimates of other inputs were derived from relevant literature sources and databases. Women in whom the<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>was positive or inconclusive continued to receive<jats:styled-content style=\"fixed-case\">RAADP<\/jats:styled-content>, whereas women with a negative result received none. Five alternative strategies in which the use of<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>may affect the existing postpartum care pathway were considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Costs expressed in 2015<jats:styled-content style=\"fixed-case\">GBP<\/jats:styled-content>and impact on health outcomes expressed in terms of quality\u2010adjusted life\u2010years over a lifetime.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results suggested that<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>appears cost saving but also less effective than current practice, irrespective of the postpartum strategy evaluated. A postpartum strategy in which inconclusive test results are distinguished from positive results performed best.<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>is only cost\u2010effective when the overall test cost is \u00a326.60 or less.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>would reduce unnecessary treatment with routine anti\u2010D immunoglobulin and is cost saving when compared with current practice. The extent of any savings and cost\u2010effectiveness is sensitive to the overall test cost.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NIPT<\/jats:styled-content>is cost saving compared with providing anti\u2010D to all RhD\u2010negative pregnant women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15152","type":"journal-article","created":{"date-parts":[[2018,2,7]],"date-time":"2018-02-07T20:26:36Z","timestamp":1518035196000},"page":"1414-1422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["High\u2010throughput, non\u2010invasive prenatal testing for fetal Rhesus D genotype to guide antenatal prophylaxis with anti\u2010D immunoglobulin: a cost\u2010effectiveness analysis"],"prefix":"10.1111","volume":"125","author":[{"given":"P","family":"Saramago","sequence":"first","affiliation":[{"name":"Centre for Health Economics University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Yang","sequence":"additional","affiliation":[{"name":"Medical School University of Exeter Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Llewellyn","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Palmer","sequence":"additional","affiliation":[{"name":"Centre for Health Economics University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Simmonds","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Griffin","sequence":"additional","affiliation":[{"name":"Centre for Health Economics University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,15]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Hospital Episode Statistics Analysis Health and Social Care Information Centre.Hospital Episode Statistics: NHS maternity statistics \u2013 England 2013\u201314. 2015 [www.hscic.gov.uk\/catalogue\/PUB16725]. 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