Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial
Abstract Background There are a large number of infertile couples in China, but its treatment is notoriously expensive and not currently covered by insurance. The utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization has been debated. Objective To investig...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-05563-z |
| _version_ | 1797845729304117248 |
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| author | Xuan He Xiao Wang Jiaojie Shen Bin Wan Yingpeng Wang Zhuolin Zhang Lele Cai Yuwen Bao Haixia Ding Xin Li |
| author_facet | Xuan He Xiao Wang Jiaojie Shen Bin Wan Yingpeng Wang Zhuolin Zhang Lele Cai Yuwen Bao Haixia Ding Xin Li |
| author_sort | Xuan He |
| collection | DOAJ |
| description | Abstract Background There are a large number of infertile couples in China, but its treatment is notoriously expensive and not currently covered by insurance. The utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization has been debated. Objective To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. Methods Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Main outcome measures Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention. Results The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional treatment. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24–98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. The incremental cost-effectiveness for miscarriage prevention showed that the willingness to pay would be ¥43422.60 for PGT-A to be cost-effective. Conclusion The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate and the high costs of PGT‑A. |
| first_indexed | 2024-04-09T17:43:38Z |
| format | Article |
| id | doaj.art-30627684a97e4dc793d16590c55cea50 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-09T17:43:38Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-30627684a97e4dc793d16590c55cea502023-04-16T11:27:45ZengBMCBMC Pregnancy and Childbirth1471-23932023-04-0123111010.1186/s12884-023-05563-zCost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trialXuan He0Xiao Wang1Jiaojie Shen2Bin Wan3Yingpeng Wang4Zhuolin Zhang5Lele Cai6Yuwen Bao7Haixia Ding8Xin Li9School of Health Policy and Management, Nanjing Medical UniversitySchool of Health Policy and Management, Nanjing Medical UniversitySchool of Pharmacy, Nanjing Medical UniversityDepartment of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical UniversityDepartment of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical UniversitySchool of Pharmacy, Nanjing Medical UniversitySchool of Pharmacy, Nanjing Medical UniversitySchool of Health Policy and Management, Nanjing Medical UniversityDepartment of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical UniversitySchool of Health Policy and Management, Nanjing Medical UniversityAbstract Background There are a large number of infertile couples in China, but its treatment is notoriously expensive and not currently covered by insurance. The utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization has been debated. Objective To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. Methods Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Main outcome measures Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention. Results The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional treatment. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24–98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. The incremental cost-effectiveness for miscarriage prevention showed that the willingness to pay would be ¥43422.60 for PGT-A to be cost-effective. Conclusion The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate and the high costs of PGT‑A.https://doi.org/10.1186/s12884-023-05563-zIn vitro fertilizationPreimplantation genetic testingAneuploidyCost-effectivenessCESE-PGS trial |
| spellingShingle | Xuan He Xiao Wang Jiaojie Shen Bin Wan Yingpeng Wang Zhuolin Zhang Lele Cai Yuwen Bao Haixia Ding Xin Li Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial BMC Pregnancy and Childbirth In vitro fertilization Preimplantation genetic testing Aneuploidy Cost-effectiveness CESE-PGS trial |
| title | Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial |
| title_full | Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial |
| title_fullStr | Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial |
| title_full_unstemmed | Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial |
| title_short | Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial |
| title_sort | cost effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in china an economic evaluation using evidence from the cese pgs trial |
| topic | In vitro fertilization Preimplantation genetic testing Aneuploidy Cost-effectiveness CESE-PGS trial |
| url | https://doi.org/10.1186/s12884-023-05563-z |
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