Cost-Effectiveness Analysis of Selective and Non-Selective Anti-D IgG Prophylaxis: Retrospective Data from a Tertiary Referral Birth Center

Objective: This study aimed to compare selective and non-selective antenatal prophylaxis approaches in terms of cost-effectiveness in pregnant women who delivered with RhD incompatibility in Kayseri City Hospital in 2024.Material and Methods: This retrospective study compared the costs of a selective antenatal prophylaxis model that combines fetal aneuploidy screening with RhD status, which could be an alternative to non-selective antenatal anti-D IgG prophylaxis administered to 1232 pregnant women with RhD incompatibility who were previously unalloimmunized. In the selective antenatal prophylaxis scenario, fetal DNA testing was performed on pregnant women at 12 weeks' gestation to determine fetal RhD status and fetal aneuploidies. Pregnant women with a positive or indeterminate fetal RhD status received anti-D IgG prophylaxis. Puerperal women who gave birth to RhD-positive offspring and had a negative postpartum indirect Coombs test were administered 1500 IU anti-D IgG prophylaxis within 72 hours.Results: In the alternative selective prophylaxis scenario, in which fetal DNA testing is routinely performed for all pregnancies at 12 weeks and antenatal anti-D IgG is administered only to cases with a positive or inconclusive fetal RhD status, the total annual cost and cost per pregnancy were found to be higher; however, the administered dose of anti-D IgG and the number of indirect Coombs tests performed were markedly reduced. Because the negative predictive value of the test for detecting fetal RhD status is 100%, no RhD-positive fetus was reported as a false negative, and no increase in the rate of alloimmunization was observed. In this approach, the cost per patient was calculated as 387 USD; therefore, the alternative selective model is 264.7 USD more expensive per patient compared with the non-selective model.Conclusion: Although the cost of the selective antenatal prophylaxis approach was found to be higher than that of the non-selective antenatal prophylaxis approach, the total amount of Anti-D IgG administered and the number of indirect Coombs tests performed were lower. Moreover, aneuploidy screening can also be conducted with high sensitivity within the selective antenatal prophylaxis model. Given these advantages, this approach appears to be a promising option for the future, particularly as its cost is expected to decline over time.