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.
