Cost implications of routine antenatal administration of Rh immune globulin.

Using decision analysis, we estimated the benefits, risks, and costs of a program for routine antepartum administration of Rh immune globulin to Rh-negative primiparous women, who were studied through their second deliveries. The number of births of second-order infants with Rh hemolytic disease of the newborn averted by an antepartum program for 10,000 Rh-negative primiparous women was estimated by race to be white, 14; black, 18; and Asian, 35. For all races, the costs incurred by an antepartum program were more than double the costs averted. Sensitivity analyses showed that the most crucial factor influencing the benefits of routine antepartum administration of Rh immune globulin is the probability of severe chronic disability from hemolytic disease of the newborn. Current data are unavailable for the probability of this event. Another factor affecting the program's benefits is the rate of antepartum Rh sensitization among primiparous women. If the program were restricted to primiparous women at high risk for antepartum Rh sensitization, its benefits might exceed its costs.