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

K. Neumann, K. 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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

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
JournalBjog-an International Journal of Obstetrics and Gynaecology
Volume127
Issue number6
DOIs
Publication statusPublished - 1 May 2020

Keywords

  • abortion
  • aneuploidy
  • array cgh
  • cost-effectiveness
  • esteem trial
  • expectant
  • ivf
  • polar body biopsy
  • pregnancy
  • preimplantation genetic testing
  • trophectoderm
  • array CGH
  • Aneuploidy
  • ESTEEM trial
  • PREGNANCY
  • EXPECTANT
  • TROPHECTODERM
  • IVF
  • ABORTION

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