A Preliminary Economic Evaluation of PGT-A in a Danish Clinical Setting

Abstract

Introduction A plummeting decline in fertility is currently observed with a Total Fertility Rate (TFR) of 1.5 across European countries. According to The World Health Organization (WHO) infertility is the inability to get pregnant after one year of trying to conceive. Fertility treatments are reproductive technologies to help individuals and couples to conceive. Assisted Reproduction Technology (ART) are fertility procedures outside of the uterus, known as in vitro. Preimplantation genetic testing- for aneuploidy (PGT-A) is a technique to predict aneuploid embryos, which are established to be more frequent in women of advanced maternal age and a majority of spontaneous miscarriage are linked to the presence of chromosomal abnormalities. PGT-A has the potential to improve fer tility outcomes by only transferring euploid embryos. PGT-A has been formerly economically assessed through cost-effectiveness studies. Thus, such studies fail to include beyond-health outcomes, and do not capture the true value of PGT-A. Methods A preliminary economic evaluation of PGT-A with a hospital perspective was conducted through a cost-utility analysis (CUA) and a cost-consequence analysis (CCA). The PGT-A RCT protocol 7.3 was utilized as the premise of this study. A systematic literature search was conducted to obtain relevant input parameters for both anal yses. A hybrid decision analytic model incorporating both a Markov model and a decision tree was generated in Tree Age to carry the CUA, and to support the results of the Incremental Cost-Effectiveness ratio (ICER) a deterministic and probabilistic sensitivity analyses was performed. The decision analytic model was developed with a parental perspective including Quality-adjusted life-year (QALY)s of both prospective parents. A time horizon of 24 months, divided in four Markov cycles of six months each, was applied. The CCA was carried out in addition to the CUA, and presented beyond-health outcomes to adequately assess the cost-effectiveness of PGT-A. Results PGT-A was more effective, however more costly compared to non-PGT-A. The ICER was 62,262.26 DKK/QALY, and PGT-A is cost-effective with the chosen WTP threshold 180,000 (£20,000) DKK/QALY. The CCA compre hended relevant clinical outcomes with PGT-A improve Live birth rate (LBR), ongoing pregnancy rate, and reducing the risk of miscarriage. Patient centred outcomes encapsulated preferences and motivations towards PGT-A, where the increased probability of a healthy child were reported as the primary motivator. Conclusion The CUA showed PGT-A to be cost-effective compared to non-PGT-A with the employed WTP threshold. Supplementary, the CCA indicated that PGT-A improved several clinical outcomes, having the potential to reduce time-to-pregnancy. Reducing the time spent in fertility treatment is advantageous for patients and couples due to the toll fertility treatment has on individuals well-being. This preliminary economic evaluation provides a foundation for future researchers and decision-makers, and a framework for the definitive economic evaluation.

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A master thesis from Aalborg University

A Preliminary Economic Evaluation of PGT-A in a Danish Clinical Setting