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

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Abstract
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.

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