• Haly S Zourob and Khaled I Abu El Aish.
• Obstetrics and Gynaecology Department, Al Helal Al Emirati Hospital, Ministry of Health, Gaza Strip, Palestine.
• Lancet. 2022 Jun 1; 399 Suppl 1: S31.

BackgroundRhesus disease of a newborn baby results from the entrance of anti-D antibodies of the rhesus factor D (RhD)-negative mother into the RhD positive foetal bloodstream. This transfer might cause stillbirths, neonatal deaths, or severe hyperbilirubinemia, which can develop into irreversible brain damage. In current practice, anti-D immunoglobulin is administered to RhD-negative women within 72 h after the delivery of RhD-positive newborn babies. During the antepartum period, it is given in events associated with placental trauma or disruption of the feto-maternal interface. This review was conducted to analyse the cost-effectiveness of the introduction of worldwide guidelines for the administration of anti-D immunoglobulin at 28 weeks to all RhD negative mothers with RhD-positive spouses in Palestine.MethodsThis was a cost-effective analysis and a literature review of the international guidelines about RhD alloimmunisation prophylaxis. The US, Australian, Canadian, UK, and WHO guidelines were reviewed. A cost-effective analysis was done, and the primary outcomes were the number needed to treat and the overall cost of the treatment. Estimations were done for the cost of prevention to every case.FindingsAll reviewed guidelines recommend that the administration of anti-D immunoglobulin is given routinely to all RhD-negative non-sensitised women at 28 weeks gestation, when the fetal blood type is unknown or the father is known to be RhD-positive. This practice is cost-effective, hence the implementation of the new guideline will cost approximately US$700 000 in Palestine ($400 000 in the West Bank and $300 000 in the Gaza Strip). The implementation of this guideline will prevent 148 cases (85 in the West Bank and 63 in the Gaza Strip) from further RhD alloimmunisation. The net cost of prevention of every case is approximately $4750.InterpretationRoutine administration of anti-D immunoglobulin to all RhD-negative non-sensitised women at 28 weeks gestation, when the spouses are RhD-positive, is cost-effective. An implementation programme for RhD alloimmunisation prophylaxis will be of great value.FundingNone.Copyright © 2022 Elsevier Ltd. All rights reserved.

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