title: Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Decision analytic model comparing costs and clinical outcomes.
  
  
  METHODS
  Academic recurrent pregnancy loss programs.
  
  
  METHODS
  Women with unexplained RPL.
  
  
  METHODS
  IVF/PGS with 24-chromosome screening and expectant management.
  
  
  METHODS
  Cost per live birth.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Palo Alto, California. Electronic address: gm807@stanford.edu.
authors.forename: Gayathree
authors.initials: G
authors.lastname: Murugappan
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Palo Alto, California.
authors.forename: Mika S
authors.initials: MS
authors.lastname: Ohno
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Palo Alto, California.
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Lathi
mesh_terms: D000026:Abortion, Habitual / Q000175:diagnosis / Q000191:economics* / Q000235:genetics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000191:economics*; D005820:Genetic Testing / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D050498:Live Birth; D018803:Models, Economic; D011237:Predictive Value of Tests; D011247:Pregnancy; D019836:Preimplantation Diagnosis / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
keywords: Cost effectiveness; in vitro fertilization; preimplantation genetic screening; recurrent pregnancy loss