OBJECTIVES: HDFN is a rare and potentially life-threatening alloimmune condition of pregnancy. There is a knowledge gap of the economic burden of the disease on the healthcare system. This study investigated the extent of healthcare resource utilization (HRU) and costs of HDFN in Israel.

METHODS: A retrospective cohort study was performed in Maccabi Healthcare Services (MHS), a 2.6-million-member health plan in Israel covering the years 1998-2021. Included were women with an HDFN diagnosis during pregnancy and their offspring from the same pregnancy or children with an HDFN diagnosis during their first year of life. HDFN diagnosis were defined by ICD-9 or ICD-10 codes excluding ABO alloimmunisation.

RESULTS: During 73 HDFN pregnancies, 27.4% were hospitalized a median of 2 times (IQR 1-2); 91.8% and 56.2% visited a gynecologist and general practitioner, respectively. Among 20 severe HDFN pregnancies, 45% were hospitalized during pregnancy.

During the first year of life, more than 20% of 450 HDFN newborns visited an ophthalmologist or an ear nose and throat specialist (ENT). The majority of children (1-18 years of age) affected by HDFN were treated by an ENT (62.6%) or an ophthalmologist (72.5%).

The average HRU costs through pregnancy, first year of life and up to 18 years of age are estimated to be 27,790 US$ (95% CI 24,189-32,047).

CONCLUSIONS: This study quantified the HRU and costs of an average HDFN case from time of diagnosis during pregnancy until the end of childhood, in Israel. HDFN pregnant women seem to be hospitalized at high rates, specifically those with severe HDFN. Moreover, the high frequency of visits to ophthalmologists or ENTs, both in the first year as throughout childhood, may suggest that HDFN-affected children experience long-term audiovisual complications. Further research is needed to corroborate these data and to fully understand the impact of HDFN on healthcare systems.