Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies which can cause severe intracranial haemorrhage (ICH) in fetuses and new-borns. Screening for human platelet antigen-1a (HPA-1a) directed antibodies during pregnancy could allow for timely intervention with antenatal treatment and prevent the occurrence of ICH. We aim to assess the cost-effectiveness of adding screening for anti-HPA-1a to the prenatal screening program. Design: A decision analysis model was developed. Setting: The Netherlands. Population: 171,713 pregnant women. Methods: Lifetime costs and effects of antenatal anti-HPA-1a screening with subsequent diagnostic and treatment interventions were compared to the current situation without screening in the Netherlands. Model parameters were based on literature and expert opinions. One-way-sensitivity analysis and probabilistic sensitivity analysis were performed. Main Outcome Measures: Incremental cost-effectiveness ratio (ICER). Results: Adding screening for HPA-1a antibodies to the current antenatal screening program of the Netherlands will lead to an additional cost of 4.7 million euro and a gain of 226 Quality-Adjusted Life Years (QALY) per year, indicating an ICER of \euro20,782 per QALY gained. One-way sensitivity analysis showed that the uncertainty around the incidence of ICH, lifetime costs of disabled children and the probability of having antibody quantitation >3.0 IU/ml at 20 weeks had the highest effect on the ICER. Conclusion: Antenatal HPA-1a screening might be cost-effective. To obtain more knowledge and thereby reduce the uncertainty on risk stratification, a pilot screening program is warranted. Funding: Sanquin

Objective To study the preferences and risk tolerance of women suffering from deep endometriosis (DE) with bowel involvement when they have to choose between conservative or surgical. Design Labelled Discrete Choice Experiment (DCE). Setting Dutch academic and non-academic hospitals and online recruitment. Population or Sample A total of 169 patients diagnosed with DE of the bowel. Methods Baseline characteristics and the fear for surgery were collected. Women were asked to rank attributes and choose between hypothetical conservative (medication) or surgical treatment in different choice sets (scenarios). Each choice set offered different levels of all treatment attributes. Data were analysed by using multinomial logistic regression. Main Outcome Measures The following attributes; effect/or risk on pain, fatigue, pregnancy, endometriosis lesions, mood swings, osteoporosis, temporary stoma and permanent intestinal symptoms were used in this DCE. Results In the ranking osteoporosis is the least important attribute, while in the DCE, a lower chance of osteoporosis is one of the most important drivers when choosing a conservative treatment. Women with previous surgery show less fear for surgery compared to women without surgery. The low anterior resection syndrome is almost equally important for patients as the chance of pain reduction. Pain reduction has higher importance than improving fertility chances even in women with a future child wish. Conclusions The risk of suffering from LARS as a result of treatment is almost equally important as the reduction of pain symptoms. Women with previous surgery experience less fear for surgery compared to women without a surgical history.