Details of HTA project
Last updated: 12 November 2008 - Next update due: 18 November 2008
Research type: |
NICE Technology Assessment Report (TAR) |
Project title: |
Pregnancy - routine anti-D prophylaxis for rhesus negative women (review) (update of NICE Guidance 41 with inclusion of a new drug - rhophylac) |
Link to NICE guidance page |
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Project ref: |
07/05/01 |
Cost: |
This project has been commissioned by the HTA programme on behalf of the National Institute for Health and Clinical Excellence on a call-off contract basis. |
Chief Investigator : |
School of Health and Related Research (ScHARR-TAG), University of Sheffield |
Start Date: |
June 2007. |
Publication date: |
January 2009. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
People who are RhD-positive have a protein on their red blood cells called D antigen. Approximately 85% of the population is RhD-positive, although the percentage varies slightly across ethnic groups. Fetal blood type is jointly inherited from the parents and therefore may differ from the mother's blood type. Fetal blood cells sometimes enter maternal circulation known as fetomaternal haemorrhage (FMH) which is normally without any adverse effects. There is more likelihood of FMH in cases of any maternal bleeding, abdominal trauma or at delivery. If the mother is RhD-negative and her baby is RhD-positive, maternal blood cells produce D antibodies which can enter into fetal circulation in future pregnancies. These antibodies can then cross the placenta into the fetal circulation and cause abnormal destruction of fetal blood cells, leading to Haemolytic disease of the newborn (HDN). No first child of an RhD-negative woman will be affected, unless the mother has been sensitised (become reactive to RhD positive blood cells previously) as a result of a prior miscarriage, abortion, prenatal diagnostic test, external cephalic version or, rarely, by a sensitising event earlier in the pregnancy. HDN can range in severity from being detectable only in laboratory tests, through to stillbirth, birth of infants with severe disabilities or death of newborn children from anaemia and jaundice. Data from 20021 suggest that each year in England and Wales there are about 105,000 births to RhD-negative women, some 17% of all births. Of these babies, about 59%, or 62,000, are RhD-positive. This represents about 10% of all births each year in England and Wales. Before immunoprophylaxis became available, the frequency of HDN was 1% of all births and HDN was responsible for the death of one baby in every 2200 births. Anti-D prophylaxis (mostly administered postnatally) and advances in neonatal care had at that time reduced the frequency of HDN to 1 in 21,000 births. The aim of this review is to systematically evaluate and appraise the potential clinical and cost effectiveness of the use of routine anti-D prophylaxis for RhD-negative women. The outcome measures to be considered are likely to include the reduction in sensitisation (alloimmunisation) of RhD-negative women, reduction in incidence of haemolytic disease of the newborn, survival of the child, disability of the child, health-related quality of life and adverse effects of treatment. |
Abstract: |
This review will consider whether there have been any advances in practice in the use of anti-D since the 2002 NICE assessment. It will assess the current clinical and cost-effectiveness of anti-D prophylaxis for rhesus negative women. The NIHR HTA programme commissioned this report on behalf of the National Institute for Health and Clinical Excellence. |
NRR* number, if applicable: |
N0484196334 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1670 |
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