Procedure Specific Cost-Effectiveness Analysis of Implementing a Rhesus D Genotyping Targeted Rhesus D Negative Pregnancy Monitoring Program in Turkey

Aim: To analyze the feasibility of fetal Rhesus D (RhD) genotyping targeted antenatal anti-D prophylaxis program under the specific conditions of Turkey. Material and Method: An analyzing method was built to compare the two prophylaxis programs by utilizing national perinatal statistics, published literature, hospital patient records and national cost resources. Results: The incidence of RhD negative pregnancy and RhD negative fetus in those pregnancies, were 10.1% and 21.4%, respectively. The attendance rate of antenatal and postnatal prophylaxis programs were 26.3% and 66.7%, respectively and 7% of those patients required additional doses. The average cost of anti-D immunoglobulin was 77.7 US$. The average per pregnancy cost of universal antenatal prophylaxis program was 148.6 US$. The individual cost of RhD gene genotyping shouldn’t be exceeding 13.7 US$ not to increase expenditure. In the case of program implementation; 551 (0.38%) patients would be falsely excluded and additional 6328 (4.37%) patients had to receive unnecessary prophylaxis each year. Conclusion: Antenatal RhD genotyping is bearing additional cost in all clinical scenarios when followed by postpartum prophylaxis. The implementation of RhD genotyping targeted anti-D prophylaxis program in Turkey would not be a cost-effective approach, due to the facts that the number and proportion of patients who cause cost reduction were found to be far more lower than European countries and that the existing patient population is mostly applying to hospitals appropriate for postpartum prophylaxis. However, it would be an ethical approach to inform patients at the individual level about the potential benefits of antenatal RhD genotyping