An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Abstract

Objective What are the cost per live birth and the incremental cost of preventing a miscarriage with preimplantation genetic testing for aneuploidy (PGT‐A) by polar body biopsy and array‐based comprehensive genome hybridisation (aCGH) versus regular IVF/ICSI without PGT‐A for infertility treatment in women 36–40 years of age? Design Decision tree model. Population A randomised clinical trial on PGT‐A (ESTEEM study). Methods Two treatment strategies were compared: one cycle of IVF/ICSI with or without PGT‐A. Costs and effects were analysed with this model for four different cost scenarios: high‐, higher medium, lower medium and low‐cost. Base case, sensitivity, threshold, and probabilistic sensitivity analyses were used to examine the cost‐effectiveness implications of PGT‐A. Results PGT‐A increased the cost per live birth by approximately 15% in the high‐cost scenario to approximately 285% in the low‐cost scenario. Threshold analysis revealed that PGT‐A would need to be associated with an absolute increase in pregnancy rate by 6% to >39% or, alternatively, would need to be US$2,969 (high‐cost scenario) to US$4,888 (low‐cost scenario) cheaper. The incremental cost to prevent one miscarriage by PGT‐A using the base case assumptions was calculated to be US$34,427 (high‐cost scenario) to US$51,146 (low‐cost scenario). A probabilistic sensitivity analysis showed cost‐effectiveness for PGT‐A from 1.9% (high‐cost scenario) to 0.0% (low‐cost scenario) of calculated samples. Conclusions While avoiding unnecessary embryo transfers and miscarriages are important goals, patients and doctors need to be aware of the high‐cost implications of applying PGT‐A using aCGH on polar bodies. Tweetable abstract PGT‐A by polar body biopsy and comprehensive genome hybridisation increases cost per live birth and requires high financial spending per miscarriage averted.

An Economic Analysis of Aneuploidy Screening of Oocytes in Assisted Reproduction in Germany

“…The decision tree mode was modelled from the point of view of patients and does not take account of the costs incurred if a miscarriage occurs (relative risk PGT-A: 0.48) or the costs of a twin pregnancy (relative risk PGT-A: 0.54), which introduces bias against PGT-A. However, another cost analysis we carried out using four different international cost scenarios which took the costs of miscarriage into account also did not find that PGT-A was cost-effective [19]. A calculation of the incremental incurred cost of PGT-A to prevent a single miscarriage showed a cost dimension (at least € 73 434), which makes using PGT-A to reduce the rate of miscarriages unrealistic from an economic perspective.…”

Reproductive outcomes of infertile couples undergoing assisted reproductive technology who are carriers of chromosomal abnormalities: a retrospective cohort study

“…Some studies have failed to show improvements in live birth rates for women younger than 37 years of age [ 20–22 ], so it seems unlikely that the added complexity and cost of this intervention can be justified in younger patients. An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in woman of advanced maternal age showed that PGT-A greatly increased the cost and suggested that patients and doctors need to be aware of the high-cost implications of applying PGT-A [ 23 ].…”

Effects of Chromosomal Abnormalities on Assisted Reproductive Technology: A Retrospective Cohort Study

“…Some studies have failed to nd improvement in live birth rates for women younger than 37 years of age [14] [15] [16], so it seems unlikely that the added complexity and cost of this intervention can be justi ed in younger patients. An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age showed PGT-A increased the cost greatly and suggested patients and doctors need to be aware of the high-cost implications of applying PGT-A [17].…”