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

K Neumann, Karen Sermon, P Bossuyt, V Goossens, J Geraedts, J Traeger-Synodinos, M Parriego, A Schmutzler, K van der Ven, W Rudolph-Rothfeld, R Vonthein, G Griesinger

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)710-718
Number of pages9
JournalBritish Journal of Obstetrics and Gynaecology
Volume127
Issue number6
DOIs
Publication statusPublished - 2020

Bibliographical note

© 2020 Royal College of Obstetricians and Gynaecologists.

Keywords

  • Abortion, Spontaneous/genetics
  • Adult
  • Aneuploidy
  • Cost-Benefit Analysis
  • Female
  • Genetic Testing/economics
  • Humans
  • Maternal Age
  • Polar Bodies/transplantation
  • Pregnancy
  • Preimplantation Diagnosis/economics

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