Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost-effective in the United States?

Kenneth J. Moise, Syed Shahrukh Hashmi, Kara Markham, Pedro S. Argoti, Michael Bebbington

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: To compare the efficacy and costs of three different strategies of antenatal rhesus immune globulin (RhIG) administration in a US population. Methods: A decision tree analysis was undertaken for universal antenatal RhIG administration based on RhD serologic paternity testing, universal administration without paternity, and selective antenatal RhIG administration using cell free fetal DNA (cfDNA) for RHD fetal typing. Rates of alloimmunization were calculated. Charges were determined for laboratory testing and obstetrical and neonatal treatments for the first pregnancy and cases of alloimmunization in the following pregnancy. Results: The largest number of new RhD alloimmunization cases resulted from a strategy of universal RhIG that included paternity. Fewer cases resulted from a selective strategy; the least number of cases were associated with a universal approach that discounted paternity. When the costs of first pregnancies and alloimmunized second pregnancies were combined, a universal strategy that excludes paternity had the least costs followed by a selective strategy followed by a universal strategy that included paternity. Conclusion: The use of cfDNA to determine the selective use of antenatal RhIG would not be cost-effective in the United States. Universal antenatal RhIG without paternity is more effective in preventing new cases of alloimmunization than the current ACOG guideline.

Original languageEnglish
Pages (from-to)238-247
Number of pages10
JournalPrenatal Diagnosis
Issue number3
StatePublished - Feb 2019


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