Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study

Abstract

Purpose In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an alternative to oocyte cryopreservation (OC) for women receiving gonadotoxic therapy. Anticipating increased use of OTC, we compare the cost-effectiveness of OC versus OTC for fertility preservation in oncofertility patients. Methods A cost-effectiveness model to compare OC versus OTC was built from a payer perspective. Costs and probabilities were derived from the literature. The primary outcome for effectiveness was the percentage of patients who achieved live birth. Strategies were compared using incremental cost-effectiveness ratios (ICER). All inputs were varied widely in sensitivity analyses. Results In the base case, the estimated cost for OC was $16,588 and for OTC $10,032, with 1.56% achieving live birth after OC, and 1.0% after OTC. OC was more costly but more effective than OTC, with an ICER of $1,163,954 per live birth. In sensitivity analyses, OC was less expensive than OTC if utilization was greater than 63%, cost of OC prior to chemotherapy was less than $8100, cost of laparoscopy was greater than $13,700, or standardized discounted costs were used. Conclusions With current published prices and utilization, OC is more costly but more effective than OTC. OC becomes costsaving with increased utilization, when cost of OC prior to chemotherapy is markedly low, cost of laparoscopy is high, or standardized discounted oncofertility pricing is assumed. We identify the critical thresholds of OC and OTC that should be met to deliver more cost-effective care for oncofertility patients.

Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?

“…107 Firstly, gamete cryopreservation (or embryo freezing) has a low return rate, making it a relatively expensive option. 87,107 The current estimate suggests that only around 5% of patients who preserve their embryos or oocytes actually return to the fertility unit to use them. In order to achieve cost-effectiveness, this return rate would need to be increased to more than 60%.…”

“…It would require a return rate of more than 80% to meet the criteria for cost-effectiveness. 107 However, careful patient selection, especially targeting individuals at risk of premature menopause, can result in higher return rates. 108 OTC offers the advantage of minimising the need for Hormonal Replacement Treatment and has shown high live birth rates through both assisted and natural conception.…”

“…The analysis of the cost effectiveness of oocyte/embryo cryopreservation versus ovarian tissue cryopreservation has certain limitations that should be considered. 107 Firstly, gamete cryopreservation (or embryo freezing) has a low return rate, making it a relatively expensive option. 87,107 The current estimate suggests that only around 5% of patients who preserve their embryos or oocytes actually return to the fertility unit to use them.…”

Fertility Preservation Options for Transgender Patients: An Overview

“…These estimated costs include 1 year of storage, with additional storage costing an average of $343/year [54]. Should patients use the cryopreserved tissue to conceive, the cost increases: a 2020 study of women who underwent cryopreservation prior to gonadotoxic chemotherapy found that when the cost of thaw and fertilization cycles and frozen embryo transfer was included, the total cost of a successful pregnancy with cryopreserved oocytes averaged $16,588 [55].…”

Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation?

“…Moreover, OTC provides the opportunity to preserve hundreds of primordial follicles at once ( Lotz et al , 2019 ), thereby not restricting women to a finite number of oocytes cryopreserved, which is a known limitation of EOC. Interestingly, a recent cost-analysis study of women undergoing onco-fertility treatment in America, demonstrated that OC was more costly than OTC ($16 588 versus $10 032, respectively) ( Chung et al , 2021 ). In a prospective study comparing the efficacy of oocyte vitrification vs OTC in women undergoing gonadotoxic treatments, higher LBRs per patient were observed in the OC group, although there was no statistical significance between the groups (32.6% versus 18.2%, respectively) ( Diaz-Garcia et al , 2018 ).…”