A cost‐effectiveness analysis of preimplantation genetic testing for aneuploidy (PGT‐A) for up to three complete assisted reproductive technology cycles in women of advanced maternal age

Evelyn Lee, Michael F. Costello, Willings C. Botha, Peter Illingworth, Georgina Mary Chambers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Current evidence suggests that preimplantation genetic testing for aneuploidy (PGT‐A) used during assisted reproductive technology improves per‐cycle live‐birth rates but cumulative live‐birth rate (CLBR) was similar to a strategy of morphological assessment (MA) of embryos. No study has assessed the cost‐effectiveness of repeated cycles with PGT‐A using longitudinal patient‐level data.

Aim: To assess the cost‐effectiveness of repeated cycles with PGT‐A compared to MA of embryos in older women.

Materials and Methods: Micro‐costing methods were used to value direct resource consumption of 2093 assisted reproductive technology‐naïve women aged ≥37 years undergoing up to three ‘complete assisted reproductive technology cycles’ (fresh plus cryopreserved embryos) with either PGT‐A or MA in an Australian clinic between 2011 and 2014. Incremental cost‐effective ratios were calculated from healthcare and patient perspectives with uncertainty assessed using non‐parametric bootstrap methods. Cost‐effectiveness acceptability curves were constructed to evaluate the probability of PGT‐A being cost‐effective over a range of willingness‐to‐pay thresholds.

Results: The CLBR and mean healthcare costs per patient were 30.90% and $22 962 for the PGT‐A group, and 26.77% and $21 801 for the MA group, yielding an incremental cost‐effective ratio of $28 103 for an additional live birth with PGT‐A. At a willingness‐to‐pay threshold of $50 000 and above, there is more than an 80% probability of PGT‐A being cost‐effective from the healthcare perspective and a 50% likelihood from a patient perspective.

Conclusion: This is the first study to use real‐world patient‐level data to assess the cost‐effectiveness of PGT‐A in older women from the healthcare and patient perspectives. The findings contribute to the ongoing debate on the role of PGT‐A in clinical practice.
LanguageEnglish
Pages573-579
Number of pages7
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume59
Issue number4
Early online date20 May 2019
DOIs
Publication statusPublished - Aug 2019
Externally publishedYes

Fingerprint

Assisted Reproductive Techniques
Maternal Age
Genetic Testing
Aneuploidy
Cost-Benefit Analysis
Live Birth
Birth Rate
Embryonic Structures
Costs and Cost Analysis
Health Care Costs
Delivery of Health Care
Uncertainty

Keywords

  • aneuploidy
  • assisted reproductive technology
  • cost-effectiveness analysis
  • cumulative live-birth rate
  • preimplantation genetic diagnosis

Cite this

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title = "A cost‐effectiveness analysis of preimplantation genetic testing for aneuploidy (PGT‐A) for up to three complete assisted reproductive technology cycles in women of advanced maternal age",
abstract = "Background: Current evidence suggests that preimplantation genetic testing for aneuploidy (PGT‐A) used during assisted reproductive technology improves per‐cycle live‐birth rates but cumulative live‐birth rate (CLBR) was similar to a strategy of morphological assessment (MA) of embryos. No study has assessed the cost‐effectiveness of repeated cycles with PGT‐A using longitudinal patient‐level data.Aim: To assess the cost‐effectiveness of repeated cycles with PGT‐A compared to MA of embryos in older women.Materials and Methods: Micro‐costing methods were used to value direct resource consumption of 2093 assisted reproductive technology‐na{\"i}ve women aged ≥37 years undergoing up to three ‘complete assisted reproductive technology cycles’ (fresh plus cryopreserved embryos) with either PGT‐A or MA in an Australian clinic between 2011 and 2014. Incremental cost‐effective ratios were calculated from healthcare and patient perspectives with uncertainty assessed using non‐parametric bootstrap methods. Cost‐effectiveness acceptability curves were constructed to evaluate the probability of PGT‐A being cost‐effective over a range of willingness‐to‐pay thresholds.Results: The CLBR and mean healthcare costs per patient were 30.90{\%} and $22 962 for the PGT‐A group, and 26.77{\%} and $21 801 for the MA group, yielding an incremental cost‐effective ratio of $28 103 for an additional live birth with PGT‐A. At a willingness‐to‐pay threshold of $50 000 and above, there is more than an 80{\%} probability of PGT‐A being cost‐effective from the healthcare perspective and a 50{\%} likelihood from a patient perspective.Conclusion: This is the first study to use real‐world patient‐level data to assess the cost‐effectiveness of PGT‐A in older women from the healthcare and patient perspectives. The findings contribute to the ongoing debate on the role of PGT‐A in clinical practice.",
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author = "Evelyn Lee and Costello, {Michael F.} and Botha, {Willings C.} and Peter Illingworth and Chambers, {Georgina Mary}",
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A cost‐effectiveness analysis of preimplantation genetic testing for aneuploidy (PGT‐A) for up to three complete assisted reproductive technology cycles in women of advanced maternal age. / Lee, Evelyn; Costello, Michael F.; Botha, Willings C.; Illingworth, Peter; Chambers, Georgina Mary.

In: Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 59, No. 4, 08.2019, p. 573-579.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Illingworth, Peter

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