A SART data cost-effectiveness analysis of planned oocyte cryopreservation versus in vitro fertilization with preimplantation genetic testing for aneuploidy considering ideal family size

For patients desiring delayed childbearing, oocyte cryopreservation is cost-effective and increases the likelihood of achieving 2 live births compared with in vitro fertilization with preimplantation genetic testing for aneuploidy.
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VOLUME 118, ISSUE 5, P875-884

Authors:

Jennifer B. Bakkensen, M.D., Kerry S.J. Flannagan, Ph.D., Sunni L. Mumford, Ph.D., Anne P. Hutchinson, M.D., Elaine O. Cheung, Ph.D., Patricia I. Moreno, Ph.D., Neil Jordan, Ph.D., Eve C. Feinberg, M.D., Kara N. Goldman, M.D.

Abstract:

Objective

To determine the cost-effectiveness of planned oocyte cryopreservation (OC) as a strategy for delayed childbearing to achieve 1 or 2 live births (LB) compared with in vitro fertilization (IVF) and preimplantation genetic testing for aneuploidy (PGT-A) at advanced reproductive age.


Design

Decision tree model with sensitivity analyses using data from the Society for Assisted Reproductive Technology Clinical Outcome Reporting System and other clinical sources.


Setting

Not applicable.


Patient(s)

A data-driven simulated cohort of patients desiring delayed childbearing with an ideal family size of 1 or 2 LB.


Intervention(s)

Not applicable.


Main Outcome Measure(s)

Probability of achieving ≥1 or 2 LB, average and maximum cost per patient, cost per percentage point increase in chance of LB, and population-level cost/LB.


Result(s)

For those desiring 1 LB, planned OC at age 33 with warming at age 43 decreased the average total cost per patient from $62,308 to $30,333 and increased the likelihood of LB from 50% to 73% when compared with no OC with up to 3 cycles of IVF/PGT-A at age 43. For those desiring 2 LB, 2 cycles of OC at age 33 and warming at age 40 yielded the lowest cost per patient and highest likelihood of achieving 2 LB ($51,250 and 77%, respectively) when compared withpursuing only 1 cycle of OC ($75,373 and 61%, respectively), no OC and IVF/PGT-A with embryo banking ($79,728 and 48%, respectively), or no OC and IVF/PGT-A without embryo banking ($79,057 and 19%, respectively). Sensitivity analyses showed that OC remained cost-effective across a wide range of ages at cryopreservation. For 1 LB, OC achieved the highest likelihood of success when pursued before age 32 and remained more effective than IVF/PGT-A when pursued before age 39, and for 2 LB, 2 cycles of OC achieved the highest likelihood of success when pursued before age 31 and remained more effective than IVF/PGT-A when pursued before age 39.


Conclusion(s)

Among patients planning to postpone childbearing, OC is cost-effective and increases the odds of achieving 1 or 2 LB when compared with IVF/PGT-A at a more advanced reproductive age.

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