Katherine T. Lofgren’s research while affiliated with Harvard University and other places

Background A controversial and unresolved question in reproductive medicine is the utility of preimplantation genetic testing for aneuploidy (PGT-A) as an adjunct to in vitro fertilization (IVF). Infertility is prevalent, but its treatment is notoriously expensive and typically not covered by insurance. Therefore, cost-effectiveness is critical to consider in this context. Objective To analyze the cost-effectiveness of PGT-A for the treatment of infertility in the United States Study design IVF cycles occurring between 2014 and 2016 in the United States, as reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, a national data registry, were analyzed. A probabilistic decision tree was developed using empiric outputs to simulate the events and outcomes associated with IVF with and without PGT-A. The treatment strategies were (1) IVF with intended PGT-A, and (2) IVF with transfer(s) of untested embryo(s). Patients progressed through the treatment model until they achieved a live birth or twelve months after ovarian stimulation. Clinical costs related to both treatment strategies were extracted from the literature and considered from both the patient and payer perspectives. Outcome metrics included incremental cost (measured in 2018 US dollars), live birth outcomes, incremental cost-effectiveness ratio (ICER) and incremental cost per live birth between treatment strategies. Results The study population included 114,157 first fresh IVF stimulations and 44,508 linked frozen embryo transfer cycles. 16.2% intended PGT-A and 83.8% did not. In patients younger than 35, PGT-A was associated with worse clinical outcomes and higher costs. At age 35 and older, PGT-A led to more cumulative births, but was associated with higher costs from both perspectives. From a patient perspective, the incremental cost per live birth favored the no PGT-A strategy from <35 until age 38, and beginning at age 39 favored PGT-A. From a payer perspective, the incremental cost per live birth favored PGT-A regardless of patient age. Conclusions The cost-effectiveness of PGT-A is dependent on patient age and perspective. From an economic perspective, routine PGT-A should not be universally adopted, but may be cost-effective in certain scenarios.