School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
School of Pharmacy, Nanjing Medical University, Nanjing, China.
BMC Pregnancy Childbirth. 2023 Apr 14;23(1):254. doi: 10.1186/s12884-023-05563-z.
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.
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.
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.
Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention.
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.
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.
中国有大量的不孕夫妇，但治疗费用昂贵，目前不在保险范围内。胚胎植入前遗传学检测非整倍体（PGT-A）作为体外受精（IVF）的辅助手段的效用一直存在争议。
从中国医疗保健系统的角度出发，研究胚胎植入前遗传学检测非整倍体（PGT-A）与常规体外受精（IVF）技术相比的成本效益。
根据 CESE-PGS 试验数据，按照 IVF 的确切步骤，建立了决策树模型，并使用中国 IVF 的成本方案。对成本进行了比较，包括每位患者的成本和成本效益。进行了单因素敏感性分析和概率敏感性分析，以确认结果的稳健性。
活产成本、每位患者的成本、预防流产的增量成本效益。
PGT-A 的平均活产成本估计为 39230.71 元，比常规治疗高 16.8%。阈值分析表明，PGT-A 需要将妊娠率提高 26.24%-98.24%，或者降低成本 4649.29 元至 1350.71 元，才能达到相同的成本效益。预防流产的增量成本约为 45600.23 元。预防流产的增量成本效益表明，PGT-A 的成本效益约为 43422.60 元。
本成本效益分析表明，从中国医疗保健提供者的角度来看，胚胎选择使用 PGT-A 并不适合常规应用，因为累积活产率和 PGT-A 的高成本。
