Cost-effectiveness of cEK-preventive matched transfusion strategies for female transfusion recipients to prevent haemolytic disease of the foetus and newborn in the Dutch healthcare setting.

BACKGROUND AND OBJECTIVES: Haemolytic disease of the foetus and newborn (HDFN) is a potentially severe condition caused by maternal alloimmunization against foetal red blood cell (RBC) antigens. In the Netherlands, female transfusion recipients under 45 years currently receive RBCs matched for c, D, E and K antigens (D and cEK-matching) to prevent alloantibody formation. We evaluated the cost versus utility of cEK-matching strategies to optimize the prevention of HDFN.

MATERIALS AND METHODS: Four strategies for females under 45 years of age were compared: current cEK-matching, cK-matching, K-matching and no antigen matching. The model used recent Dutch data on alloimmunization incidence and incorporated lifetime costs and quality-adjusted life years (QALYs). Sensitivity analyses were conducted to assess robustness across different assumptions.

RESULTS: Compared to the current cEK-matching strategy, cK-matching reduced lifetime costs by €79,000 per yearly cohort of 177,248 pregnant women, with a minor QALY loss of 0.02. Matching for K only and no matching were both associated with higher costs and greater QALY losses. Across all plausible willingness-to-pay (WTP) thresholds, cK-matching had the highest probability of being cost effective.

CONCLUSION: Transfusion matching for c and K, but not E, is the most cost-effective strategy to prevent HDFN in the Dutch setting. Matching for E provides minimal health benefit at higher costs. These findings support revising current guidelines to cK-matching, ensuring optimal prevention of HDFN while reducing healthcare expenditures.