Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss
To determine whether in vitro fertilization with preimplantation genetic screening (IVF/PGS) is cost effective compared with expectant management in achieving live birth for patients with unexplained recurrent pregnancy loss (RPL).
Design
Decision analytic model comparing costs and clinical outcomes.
Setting
Academic recurrent pregnancy loss programs.
PATIENT(S): Women with unexplained RPL.
INTERVENTION(S): IVF/PGS with 24-chromosome screening and expectant management.
MAIN OUTCOMES MEASURE(S): Cost per live birth.
RESULT(S): The IVF/PGS strategy had a live-birth rate of 53% and a clinical miscarriage rate of 7%. Expectant management had a live-birth rate of 67% and clinical miscarriage rate of 24%. The IVF/PGS strategy was 100-fold more expensive, costing $45,300 per live birth compared with $418 per live birth with expectant management.
CONCLUSION(S): In this model, IVF/PGS was not a cost-effective strategy for increasing live birth. Furthermore, the live-birth rate with IVF/PGS needs to be 91% to be cost effective compared with expectant management.
preimplantation genetic screening recurrent pregnancy loss cost-effectiveness, IVF PGS versus expectant management recurrent miscarriage, unexplained recurrent pregnancy loss treatment comparison live birth, cost per live birth IVF PGS expectant management RPL, 24 chromosome screening recurrent pregnancy loss outcomes, decision analytic model recurrent miscarriage IVF cost, expectant management live birth rate recurrent pregnancy loss, Lathi recurrent pregnancy loss preimplantation genetic screening, IVF cost-effectiveness unexplained RPL clinical miscarriage rate, natural conception versus IVF recurrent pregnancy loss
PMID 25772770 25772770 DOI 10.1016/j.fertnstert.2015.02.012 10.1016/j.fertnstert.2015.02.012 Murugappan et al. 2015, Murugappan 2015
Cite this article
Murugappan, G., Ohno, M. S., & Lathi, R. B. (2015). Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertility and sterility, 103(5), 1215-1220. https://doi.org/10.1016/j.fertnstert.2015.02.012
Murugappan G, Ohno MS, Lathi RB. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertil Steril. 2015;103(5):1215-1220. doi:10.1016/j.fertnstert.2015.02.012
Murugappan, Gayathree, et al. "Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss." Fertility and sterility, vol. 103, no. 5, 2015, pp. 1215-1220.
Keywords
Abortion, Habitual/diagnosis/economics/genetics/prevention & Control, Cost-Benefit Analysis, Decision Support Techniques, Female, Fertilization in Vitro/adverse Effects/economics, Genetic Testing/economics, Health Care Costs, Humans, Live Birth, Models, Economic, Predictive Value of Tests, Pregnancy, Preimplantation Diagnosis/economics/methods, Treatment Outcome, Cost Effectiveness, In vitro Fertilization, Preimplantation Genetic Screening, Recurrent Pregnancy Loss
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
An economic analysis of NaProTECHNOLOGY compares the total treatment costs and cost-per-live-birth outcomes against assisted reproductive technologies, including IVF, drawing on outcome data from the Pope Paul VI Institute to demonstrate that NaPro's higher per-cycle success rates yield a favorable cost-effectiveness ratio despite comparable or lower upfront expenditures. Because NaProTECHNOLOGY identifies and corrects underlying pathology rather than bypassing it, its resource utilization model supports long-term gynecological health benefits that IVF cannot provide, making the economic case inseparable from the clinical one.
To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility. Prospective, randomized clinical study. University-affiliated infertility clinic. PATIENT(S): Couples with newly diagnosed infertility and no prior treatment. INTERVENTION(S): Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility. MAIN OUTCOME MEASURE(S): Pregnancy rates and costs per couple, per month of treatment, and per pregnancy. RESULT(S): Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same. CONCLUSION(S): In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.
Add-Ons and Adjuncts · Preimplantation Genetic Testing
Preimplantation genetic testing for polygenic disorders (PGT-P) has been commercially available since 2019. PGT-P makes use of polygenic risk scores for conditions which are multifactorial and are significantly influenced by environmental and lifestyle factors. If current predictions are accurate, then absolute risk reductions range from about 0.02% to 10.1%, meaning that between 10 and 5,000 in vitro fertilization patients would need to be tested with PGT-P to prevent one offspring from becoming affected in the future, depending on the condition and the number of embryos available. Survey and interview data reveal that patients and the public have largely favorable views regarding the use of PGT-P for disease prevention; however, clinicians and professional organizations have many reservations. The use of PGT-P raises multiple social and ethical concerns including the need for adequate counseling, the setting of realistic expectations, the application of distributive justice, the impact of environmental and social determinants of health, and the potential exacerbation of health inequities. Clinicians expressed significant concerns relating to the cost of PGT-P, the potential time-consuming counseling for reproductive endocrinologists and genetic counselors, the intentional creation of supernumerary embryos, and patients' unrealistic expectations regarding "healthiest disease-free" embryos. Furthermore, current evidence lacks long-term outcome data and generalizability. Prior to offering PGT-P to patients, additional clinical validation studies are needed. Also, ethical and social considerations raised by PGT-P should be carefully delineated. Systemic practices to increase equitable access to unbiased genetic counseling and reproductive services would be desirable prior to the ethical implementation of PGT-P.
Ferrier C et al., 2023·BJOG : an international journal of obstetrics and gynaecology
To evaluate a saliva diagnostic test (Endotest®) for endometriosis compared with the conventional algorithm.
A cost-effectiveness analysis with a decision-tree model based on literature data.
France.
Women with chronic pelvic pain.
Strategy I is the French algorithm, representing the comparator. For strategy II, all patients have an Endotest®. For strategy III, patients undergo ultrasonography to detect endometrioma and patients with no endometrioma detected have an Endotest®. For strategy IV, patients with no endometrioma detected on ultrasonography undergo pelvic magnetic resonance imaging (MRI) to detect endometrioma and/or deep endometriosis. An Endotest® is then performed for patients with a negative result on MRI.
Costs and accuracy rates and incremental cost-effectiveness ratios (ICERs). Three analyses were performed with an Endotest® priced at €500, €750, and €1000. Probabilistic sensitivity analysis was conducted with Monte Carlo simulations.
With an Endotest® priced at €750, the cost per correctly diagnosed case was €1542, €990, €919 and €1000, respectively, for strategies I, II, III and IV. Strategy I was dominated by all other strategies. Strategies IV, III and II were, respectively, preferred for a willingness-to-pay threshold below €473, between €473 and €4670, and beyond €4670 per correctly diagnosed case. At a price of €500 per Endotest®, strategy I was dominated by all other strategies. At €1000, the ICERs of strategies II and III were €724 and €387 per correctly diagnosed case, respectively, compared with strategy I.
The present study demonstrates the value of the Endotest® from an economic perspective.