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Cost-effectiveness of preimplantation genetic screening for women older than 37 undergoing in vitro fertilization

Abstract

Purpose

Adding preimplantation genetic screening to in vitro fertilization has been shown to increase live birth rate in women older than 37. However, preimplantation genetic screening is an expensive procedure. Information on the cost-effectiveness of preimplantation genetic screening can help inform clinical decision making.

Methods

We constructed a decision analytic model for a hypothetical fresh, autologous in vitro fertilization cycle (with versus without preimplantation genetic screening) for women older than age 37 who had a successful oocyte retrieval and development of at least one blastocyst. The model incorporated probability and cost estimates of relevant clinical events based on data from published literature. Sensitivity analyses were performed to examine the impact of changes in model input parameters.

Results

In base-case analysis, IVF-PGS offered a 4.2 percentage point increase in live birth rate for an additional cost of $4509, yielding an incremental cost-effectiveness ratio (ICER) of $105,489 per additional live birth. This ICER was below the expected cost of $145,063 for achieving one live birth with IVF (assuming an average LBR of 13.4% and $19,415 per cycle for this patient population). Sensitivity analysis suggested that ICER improved substantially with decreases in PGS cost and increases in PGS effectiveness. Monte Carlo simulation showed PGS to be cost-effective in 93.9% of iterations at an acceptability cutoff of $145,063.

Conclusions

Considering the expected cost of achieving one live birth with IVF, PGS is a cost-effective strategy for women older than 37 undergoing IVF. Additional research on patients’ willingness-to-pay per live birth would further inform our understanding regarding the cost-effectiveness of PGS.

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Acknowledgements

We thank Ms. Jeani Chang (CDC) and Dr. Vanessa Dalton for kindly sharing unpublished data from their manuscripts for inclusion in our analysis.

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Correspondence to Winifred Mak.

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The authors declare that they have no conflicts of interest.

Electronic supplementary material

Supplemental Fig. 1

The tornado diagram shows change in estimated incremental cost-effectiveness ratio (ICER) of IVF-PGS compared to IVF without PGS when each model input parameter was varied from its minimum value to maximum value (one-way sensitivity analysis). (PDF 199 kb)

Supplemental Fig. 2

Two-way Sensitivity Analysis. This figure shows change in estimated incremental cost-effectiveness ratio (ICER) of IVF-PGS compared to IVF without PGS the cost of PGS and the odds ratio of pregnancy with IVF-PGS (vs. PGS alone) were varied simultaneously. (PDF 209 kb)

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Collins, S.C., Xu, X. & Mak, W. Cost-effectiveness of preimplantation genetic screening for women older than 37 undergoing in vitro fertilization. J Assist Reprod Genet 34, 1515–1522 (2017). https://doi.org/10.1007/s10815-017-1001-8

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Keywords

  • Cost-effectiveness
  • Preimplantation genetic screening
  • In vitro fertilization
  • Willingness-to-pay