Cost effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss

Capsule:
In vitro fertilization/preimplantation genetic screening is not cost effective in achieving live birth compared with expectant management in patients with unexplained recurrent pregnancy loss.

Authors:
Gayathree Murugappan, M.D., Mika S. Ohno, M.D., Ruth B. Lathi, M.D.

Volume 103, Issue 5, Pages 1215-1220

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).

Design:
Decision analytic model comparing costs and clinical outcomes.

Setting:
Academic recurrent pregnancy loss programs.

Patient(s):
Women with unexplained RPL.

Intervention(s):
IVF/PGS with 24-chromosome screening and expectant management.

Main Outcomes Measure(s):
Cost per live birth.

Result(s):
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.

Conclusion(s):
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.

  • globetrotter

    Why would this cost so much more? $4000 more per cycle would be expected.

  • ranjithrama

    This is an interesting study but would be infinitely more useful if IVF was compared with and without PGS. Do the authors have data?

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