title: Cost-effectiveness of cytogenetic evaluation of products of conception by chorionic villus sampling in recurrent miscarriage.
abstract: OBJECTIVE
  To compare the cost-effectiveness of performing chorionic villus sampling (CVS) of products of conception (POC) in the evaluation of recurrent miscarriage versus standard evidence-based work-up (EBW) of the couple.
  
  
  METHODS
  A decision-analytic model was performed in couples with a third miscarriage. Three strategies were considered: (1) the standard EBW of all the patients, comprising parental karyotype, uterine cavity assessment and antiphospholipid antibodies; (2) performing a CVS of POC and a standard karyotype, and if euploid, follow with EBW; and (3) performing a CVS of POC and an arrayCGH and, if normal, follow with EBW. Estimated cost and diagnostic yield of each strategy was analysed. Sensitivity analysis and threshold cost were considered.
  
  
  RESULTS
  The expected cost-effectiveness of CVS and karyotype of POC in recurrent miscarriage was: $US769.79 versus $US 1361.8 for the standard EBW of the couple. When stratified by maternal age the results remained cost-effective for this strategy. The arrayCGH strategy has a higher diagnostic yield, but still expensive in our setting to be considered cost-effective.
  
  
  CONCLUSIONS
  Chorionic villus sampling and karyotype analysis of products of conception in a third miscarriage proved a more cost-effective strategy than standard EBW of the couple. © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Centro de Educación Médica en Investigaciones Clínicas (CEMIC), Instituto Universitario - Department of Obstetrics and Gynecology, Genetic Unit, Galvan 4102, Buenos Aires, Buenos Aires 1425, Argentina.
authors.forename: Florencia
authors.identifier: http://orcid.org/0000-0002-3273-4944
authors.initials: F
authors.lastname: Petracchi
authors.affiliation: Centro de Educación Médica en Investigaciones Clínicas (CEMIC), Instituto Universitario - Department of Obstetrics and Gynecology, Genetic Unit, Galvan 4102, Buenos Aires, Buenos Aires 1425, Argentina.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Paez
authors.affiliation: Centro de Educación Médica en Investigaciones Clínicas (CEMIC), Instituto Universitario - Department of Obstetrics and Gynecology, Genetic Unit, Galvan 4102, Buenos Aires, Buenos Aires 1425, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: Igarzabal
mesh_terms: D000026:Abortion, Habitual / Q000175:diagnosis / Q000191:economics / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000782:Aneuploidy; D015193:Chorionic Villi Sampling / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D020732:Cytogenetic Analysis / Q000191:economics* / Q000379:methods; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007621:Karyotyping / Q000191:economics; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics / Q000379:methods; D015203:Reproducibility of Results; D055815:Young Adult