Preimplantation genetic screening in older women: a cost-effectiveness analysis.
OBJECTIVE
To compare the strategy of traditional IVF with prenatal diagnosis versus IVF with preimplantation genetic screening (IVF/PGS) to prevent aneuploid births in women with advanced maternal age.


METHODS
A decision tree analytic model was created to compare IVF alone versus IVF/PGS to evaluate which strategy is the least costly per healthy (euploid) infant.


METHODS
Outpatient IVF practices.


METHODS
Infertile women, 38-40 and >40 years old.


METHODS
IVF or IVF/PGS.


METHODS
Cost per healthy infant.


RESULTS
Using base-case estimates of costs and probabilities in women aged 38-40 years, after a maximum of two fresh IVF cycles and two frozen cycles, the chance of having a healthy infant was 37.8% with IVF alone versus 21.7% with IVF/PGS. The average cost for each strategy is $25,700, but the cost per healthy infant is substantially higher when IVF/PGS is applied as opposed to IVF alone ($118,713 vs. $68,026). To assess the robustness of the model, all probabilities were varied simultaneously in a Monte Carlo simulation, and in 96.2% of trials, IVF alone proved to be the most cost-effective option. Conversely, our data demonstrate that in women aged >40, IVF and IVF/PGS are essentially equal in terms of cost-effectiveness ($122,000 vs. $118,713).


CONCLUSIONS
IVF alone is less costly per healthy infant than IVF/PGS in women ages 38-40.
Mersereau
Jennifer E
JE
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA. jennifer_mersereau@med.unc.edu
Plunkett
Beth A
BA
Cedars
Marcelle I
MI
D000328:Adult; D017677:Age Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D005817:Genetic Counseling / Q000191:economics* / Q000706:statistics & numerical data; D005820:Genetic Testing / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007247:Infertility, Female / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D050498:Live Birth / Q000191:economics* / Q000453:epidemiology; D011247:Pregnancy; D019836:Preimplantation Diagnosis / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000191:economics*