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

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 $25,700, but the cost per healthy infant is substantially higher when IVF/PGS is applied as opposed to IVF alone ($118,713 vs. $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 ($122,000 vs. $118,713). Conclusion(s) IVF alone is less costly per healthy infant than IVF/PGS in women ages 38–40.