Abstract:Objective: To determine whether in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) is cost effective to achieve a live birth compared with IVF alone in fresh donor oocyte cycles. Design: Theoretical cost-effectiveness study. Setting: Not applicable. Patient(s): None. Intervention(s): Comparison between the cost of IVF with PGT-A vs. IVF alone to achieve a live birth. The model analyzed a hypothetical single fresh oocyte donor IVF cycle with PGT-A vs. IVF alone and followed… Show more
“…However, as full oocyte cohorts were not donated to one patient, it is not plausible to conclude that oocyte donors were impaired in the PGT-A cost-effective group. Moreover, Antero et al [27] showed that PGT-A is not cost-effective in IVF cycles when fresh oocyte donors in the same age range as the current study were used. PGT-A cost varies in different countries, and technology tends to be more expensive in developing countries [28].…”
Purpose To determine whether in vitro fertilization cycles using fresh oocyte donations benefit from preimplantation genetic testing for aneuploidies. Methods A paired cohort study compared 44 fresh oocyte donation cycles with or without preimplantation genetic testing for aneuploidy (PGT-A). The sibling oocyte study analyzed fertilized oocytes, blastocyst development, and euploidy rate. Only frozen embryo transfers were performed. Pregnancy, implantation, biochemical pregnancy, miscarriage, stillbirth, live birth, and twin pregnancy rates were analyzed between groups. Results Fresh oocyte donation cycles between PGT-A and non-PGT-A groups were similar in all laboratory and clinical outcomes. A euploidy rate of 74.2% was observed in the PGT-A group. Although a slight trend was observed for implantation rate in the PGT-A group, it was not statistically significant. No difference was observed for live birth between groups. Conclusion PGT-A associated with fresh oocyte donation cycles does not improve clinical outcomes and can be seen as over-treatment for patients.
“…However, as full oocyte cohorts were not donated to one patient, it is not plausible to conclude that oocyte donors were impaired in the PGT-A cost-effective group. Moreover, Antero et al [27] showed that PGT-A is not cost-effective in IVF cycles when fresh oocyte donors in the same age range as the current study were used. PGT-A cost varies in different countries, and technology tends to be more expensive in developing countries [28].…”
Purpose To determine whether in vitro fertilization cycles using fresh oocyte donations benefit from preimplantation genetic testing for aneuploidies. Methods A paired cohort study compared 44 fresh oocyte donation cycles with or without preimplantation genetic testing for aneuploidy (PGT-A). The sibling oocyte study analyzed fertilized oocytes, blastocyst development, and euploidy rate. Only frozen embryo transfers were performed. Pregnancy, implantation, biochemical pregnancy, miscarriage, stillbirth, live birth, and twin pregnancy rates were analyzed between groups. Results Fresh oocyte donation cycles between PGT-A and non-PGT-A groups were similar in all laboratory and clinical outcomes. A euploidy rate of 74.2% was observed in the PGT-A group. Although a slight trend was observed for implantation rate in the PGT-A group, it was not statistically significant. No difference was observed for live birth between groups. Conclusion PGT-A associated with fresh oocyte donation cycles does not improve clinical outcomes and can be seen as over-treatment for patients.
“…Among them, three studies [ 13 , 18 , 23 ] did not explain the research perspective; only three studies [ 16 , 18 , 22 ] stated that the discount rate was not set; the model types were defined in all the 12 studies, but Mathieu (2020) and van Eekelen (2021) did not provide a specific model structure diagram. There were no subgroups, heterogeneity analysis, and distribution effect analysis in nine studies [ 13 – 16 , 18 – 20 , 22 , 24 ], and there were no uncertainty analysis in two studies [ 18 , 19 ].…”
Section: Resultsmentioning
confidence: 99%
“…Six studies [ 16 – 19 , 21 , 23 ] restricted the age of patients. Further, six studies [ 13 , 15 , 16 , 20 , 21 , 24 ] limited the duration of treatment (the first IVF cycle) and treatment options (fresh/frozen embryo transfer). The patients in one study [ 18 ] had additional complications (endometriosis).…”
Section: Resultsmentioning
confidence: 99%
“…Among them, two studies [ 16 , 17 ] conducted the evaluation from the perspective of patients. Two studies [ 14 , 20 ] evaluated from the perspective of medical insurance payers. One study [ 24 ] evaluated from the perspective of health systems.…”
Background
With the increasing demand for fertility services, it is urgent to select the most cost-effective assisted reproductive technology (ART) treatment plan and include it in medical insurance. Economic evaluation reports are an important reference for medical insurance negotiation. The aim of this study is to systematically evaluate the economic evaluation research of ART, analyze the existing shortcomings, and provide a reference for the economic evaluation of ART.
Methods
PubMed, EMbase, Web of Science, Cochrane Library and ScienceDirect databases were searched for relevant articles on the economic evaluation of ART. These articles were screened, and their quality was evaluated based on the Comprehensive Health Economics Evaluation Report Standard (CHEERS 2022), and the data on the basic characteristics, model characteristics and other aspects of the included studies were summarized.
Results
One hundred and two related articles were obtained in the preliminary search, but based on the inclusion criteria, 12 studies were used for the analysis, of which nine used the decision tree model. The model parameters were mainly derived from published literature and included retrospective clinical data of patients. Only two studies included direct non-medical and indirect costs in the cost measurement. Live birth rate was used as an outcome indicator in half of the studies.
Conclusion
Suggesting the setting of the threshold range in the field of fertility should be actively discussed, and the monetary value of each live birth is assumed to be in a certain range when the WTP threshold for fertility is uncertain. The range of the parameter sources should be expanded. Direct non-medical and indirect costs should be included in the calculation of costs, and the analysis should be carried out from the perspective of the whole society. In the evaluation of clinical effect, the effectiveness and safety indexes should be selected for a comprehensive evaluation, thereby making the evaluation more comprehensive and reliable. At least subgroup analysis based on age stratification should be considered in the relevant economic evaluation.
“…Based on the current costs of embryo biopsy and PGT-A, the procedure seems approximately cost neutral at worst and cost effective at best for patients who have enough embryos for more than 1 live birth. Cost effectiveness studies based on data more than 5 or 10 years or data from multiple centers may not be applicable to current practice at centers proficient in embryo biopsy and PGT-A [ 18 ]. Fig.…”
Purpose
To determine if blastocyst trophectoderm biopsy for PGT-A is associated with an increased rate of live birth per embryo in good prognosis IVF patients at a single center.
Methods
We performed a retrospective cohort study of good prognosis embryo transfer cycles at a single center from 1/1/2017 to 12/31/2019. We evaluated the rate of live birth per embryo with and without PGT-A for transfer of embryos in two groups of good prognosis patients: embryos from donor oocytes and embryos from autologous oocytes with maternal age less than 35 years at oocyte retrieval. Two-sided Fisher’s exact tests were used for comparisons between groups.
Results
After transfer of embryos created from donor oocytes the live birth rate per euploid embryo was 70.6% (24/34) compared to 34.3% (35/102) for untested embryos for a rate difference of 36.3% (95% CI 18.4–54.1%, p < 0.01). After transfer of embryos created from autologous oocytes with maternal age less than 35 years at oocyte retrieval the live birth rate per euploid embryo was 70.0% (49/70) compared to 52.5% (53/101) for untested embryos for a rate difference of 17.5% (95% CI 3.0–32.0%, p = 0.03).
Conclusions
In good prognosis patients at our center the live birth rate per euploid blastocyst was higher than for untested blastocysts.
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