Preimplantation genetic screening in older women: a cost-effectiveness analysis.

摘要

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. DESIGN: 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. SETTING: Outpatient IVF practices. PATIENT(S): Infertile women, 38-40 and >40 years old. INTERVENTION(S): IVF or IVF/PGS. MAIN OUTCOME MEASURE(S): Cost per healthy infant. RESULT(S): 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 Dollars 25,700, but the cost per healthy infant is substantially higher when IVF/PGS is applied as opposed to IVF alone (Dollars 118,713 vs. Dollars 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 (Dollars 122,000 vs. Dollars 118,713). CONCLUSION(S): IVF alone is less costly per healthy infant than IVF/PGS in women ages 38-40.