• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

What is the Value of Using NIPT as a Diagnostic Test for Fetal RhD status?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Saramago et al. (BJOG, 2018) evaluated the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal Rhesus D (RhD) genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared with routine antenatal anti-D immunoglobulin prophylaxis (RAADP)
  • This study was devised to inform NICE recommendations

METHODS:

  • Cost-effectiveness decision-analytic modeling
    • A decision tree model was used to characterize the antenatal care pathway in England and the long-term consequences of sensitization events
  • The diagnostic accuracy of HT-NIPT was derived from relevant literature sources and databases
  • HT‐NIPT is assumed to be introduced early enough in the care pathway to guide the use of anti-D immunoglobulin at 28 weeks of gestation
  • For women with false‐negative HT‐NIPT results who receive only postpartum anti‐D immunoglobulin, the model assumes a rate of sensitization of 0.95%
  • HT-NIPT is considered highly accurate (treating inconclusive result as positive)
    • Sensitivity: 0.998
    • Specificity 0.942

Five alternative strategies measuring the impact HT-NIPT would have on existing postpartum care were considered

  • Current practice
    • Postpartum cord serology for all; fetal-maternal hemorrhage testing as necessary and anti-D immunoglobulin based on fetal-maternal hemorrhage results
  • HT-NIPT Strategy 1
    • Any HT-NIPT RhD result: Postpartum cord serology; fetal-maternal hemorrhage testing and anti-D immunoglobulin as appropriate
  • HT-NIPT Strategy 2
    • Negative result treated as diagnostic (potential for false negatives)
    • Positive or inconclusive confirmed with cord blood serology
  • HT-NIPT Strategy 3
    • RhD-negative result requires confirmation
    • Positive (including inconclusive) treated as diagnostic (potential to overtreat false positives)
  • HT-NIPT Strategy 4
    • All NIPT results treated as diagnostic, with inconclusive treated as positive
  • HT-NIPT Strategy 5
    • NIPT negative requires cord blood confirmation
    • NIPT positive does not require cord blood confirmation
    • Inconclusive requires cord blood confirmation

RESULTS:

  • HT-NIPT is highly accurate and appears to be economical, but also less effective than current practice, irrespective of the postpartum strategy evaluated
    • Authors found the “magnitude of the potential cost‐savings appeared sufficient to outweigh the small increase in sensitisations and the associated small QALY loss”
  • A postpartum strategy in which inconclusive test results are distinguished from positive results lead to the best performance (Strategy 5)
  • The cost-effectiveness of HT-NIPT is dependent on the overall test cost being less than or equal to £26.60

CONCLUSION:

  • HT-NIPT could reduce unnecessary treatment with routine anti-D immunoglobulin and is cost saving compared to current practice
  • Authors point out an important limitation – data on the diagnostic accuracy of HT-NIPT among non-white ethnicity is lacking and this group of pregnant women may have more inconclusive test results

Learn More – Primary Sources:

High‐throughput, non‐invasive prenatal testing for fetal Rhesus D genotype to guide antenatal prophylaxis with anti‐D immunoglobulin: a cost‐effectiveness analysis

image_pdfFavoriteLoadingFavorite

< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Results of the SALVO Trial: Cell Salvage During Cesarean Section
When to Administer Anti-D Immune Globulin to Prevent Rh D Alloimmunization
Practical obstetrics info for your women's healthcare practice
Alloimmunization and Red Cell Antibodies – Time to be Concerned?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site