Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss

Murugappan, Gayathree; Ohno, Mika; Lathi, Ruth B.

doi:10.1016/j.fertnstert.2015.02.012

Cited by 68 publications

(39 citation statements)

References 20 publications

(27 reference statements)

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“…12,13 The financial cost of a miscarriage was assumed to be US $1,300, US$600, US$200, and US$100 for high-, higher medium, lower medium, and low-cost scenario as previously reported. [14][15][16][17][18] All assumptions incorporated into this analysis included direct medical costs only, as indirect costs are highly variable and difficult to calculate. Costs for a previous diagnostic work-up before treatment were not included but assumed to be equal.…”

Section: Ivf Cost Scenariosmentioning

confidence: 99%

“…A one-way sensitivity analysis investigated PGT-A cost scenarios ranging from US$1,000 to 10,000 in intervals of US$250, reflecting the great variations of international PGT-A costs. 16 Threshold analysis and incremental costeffectiveness ratio A threshold analysis for the maximum cost of PGT-A which would still provide cost-effectiveness was conducted for all scenarios. The theoretical necessary threshold for the clinical pregnancy rate to achieve cost-effectiveness of PGT-A was also estimated.…”

Section: Cost For Pgt-amentioning

confidence: 99%

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

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

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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.

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Section: Ivf Cost Scenariosmentioning

confidence: 99%

Section: Cost For Pgt-amentioning

confidence: 99%

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

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

View full text Add to dashboard Cite

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“…Three studies have evaluated the cost‐effectiveness of PGT‐A version 2. Murugappan et al, applying PGT‐A to patients with unexplained recurrent miscarriages compared to expectant management, showed that PGT‐A could decrease abortion rate while live birth rate was not improved. Results of the analysis of the costs per live birth showed that IVF/PGT‐A was 100‐fold more expensive and consequently was not cost‐effective in increasing live birth.…”

Section: Threatsmentioning

confidence: 99%

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

et al. 2019

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The recently re‐named pre‐implantation genetic testing for determining embryo aneuploidies (PGT‐A) is presently very popular although its acceptance by the scientific community is controversial. This approach still encounters drawbacks. This paper uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to discuss salient points to be considered when examining the pre‐implantation genetic testing (PGT‐A) strategy to gather information from a range of perspectives. One of the strengths associated with the procedure is represented by an increase in implantation rate although data from the highest level of evidence do not support an increase in cumulative pregnancy rates. The current difficulty in the management of mosaicisms represents a weakness of PGT‐A. The application of the strategy represents an opportunity to favor the single embryo transfer while other advantages, such as reduction of time to pregnancy and emotional distress are controversial. Potential important threats, at present still undefined, are represented by the biopsy‐related damage to the blastocyst and the impact on neonatal and long‐term outcomes.

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“…PGT-A is the technique to select euploid embryos with the best implantation potential. This technique has been applied to treat patients with an increased risk of having aneuploid embryos, such as those with advanced maternal age 1,23 , repeated implantation failure 24 , and recurrent miscarriage [25][26][27] . Up to date, PGT-A studies remain limited and have not been reported for the clinical outcomes in patients with advanced maternal age in Vietnam.…”

Section: Introductionmentioning

confidence: 99%

Selecting euploid embryo for transfer by preimplantation genetic testing for aneuploidy improved clinical outcomes in patients with advanced maternal age

Phượng¹,

Thuc²,

Quan³

et al. 2019

Biomed. Res. Ther.

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Objectives: This study aimed to investigate whether selecting euploid embryos by preimplantation genetic testing for aneuploidy (PGT-A) can improve the clinical outcomes in patients with advanced maternal age. Hence, it provides evidence about the role of PGT-A in the treatment for patients with advanced maternal age in Vietnam. Methods: This is a retrospective cohort study, conducted at IVFMD, My Duc Hospital, Vietnam, from March 2017 to March 2019. There were 244 patients taking preimplantation genetic testing for aneuploidy (PGT-A group). Biopsy was performed at the blastocyst stage. On the day of biopsy, about 5-6 trophectoderm cells were collected and sent to analysis, while the remaining was individually vitrified to be used for embryo transfer to the patient. When patients had PGT-A, the clinician consulted and indicated the euploid embryo for frozen embryo transfer cycle. The ongoing pregnancy rate was compared with the group of patients who only performed blastocyst transfer (non-PGT-A group). Other outcomes, such as the average number of transferred embryos, clinical pregnancy rate, implantation rate, miscarriage rate and multiple pregnancy rate, were also compared between the two groups. Results: In the total of 493 patients fulfilled the inclusion criteria, there were 244 patients in PGT-A group and 249 patients in non-PGT-A group. The patient characteristics of the two groups were similar (p > 0.05). A total of 816 blastocysts were biopsied and 315 (38.6%) of these were aneuploidy. The ongoing pregnancy rate of PGT-A group was significantly higher than non-PGT-A group (43.9% vs. 32.1%, p = 0.01). Moreover, mean number of transferred embryos and multiple pregnancy rate of PGT-A group was lower than non-PGT-A group (1.3 vs. 2, p < 0.001; 5.7% vs. 12%, p < 0.001, respectively). Conclusions: In patients with advanced maternal age, the transfer of euploidy embryos selected by PGT-A improved the ongoing pregnancy rate and reduced the number of transferred embryos and multiple pregnancy rate. Therefore, this group of patients may benefit from PGT-A.

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Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss

Cited by 68 publications

References 20 publications

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

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

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

Selecting euploid embryo for transfer by preimplantation genetic testing for aneuploidy improved clinical outcomes in patients with advanced maternal age

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