Cost-effectiveness of IVF with PGT-M/A to prevent transmission of spinal muscular atrophy in offspring of carrier couples

Abstract

Purpose: To evaluate the cost-effectiveness of in-vitro fertilization with preimplantation genetic testing for aneuploidy and monogenic disorders (IVF with PGT-M/A) to prevent transmission of spinal muscular atrophy to offspring of carrier couples.

Methods: A decision-analytic model was created to compare the cost-effectiveness of IVF with PGT-M/A to unassisted conception with prenatal diagnostic testing and termination (if applicable). IVF with PGT-M/A costs were determined using a separate Markov state-transition model. IVF outcomes data was derived from 76 carriers of monogenic disorders who underwent IVF with PGT-M/A at a single academic REI center. Other probabilities, costs, and utilities were derived from the literature. Costs were modeled from healthcare perspective. Utilities were modeled from the parental perspective as quality-adjusted life-years (QALYs).

Results: The incremental cost-effectiveness ratio for IVF with PGT-M/A compared to unassisted conception is $22,050 per quality-adjusted life-year. The average cost of IVF with PGT-M/A is $41,002 (SD: $8,355). At willingness-to-pay thresholds of $50,000 and $100,000, IVF with PGT-M/A is cost-effective 93.3% and 99.5% of the time, respectively.

Conclusions: Compared to unassisted conception, IVF with PGT-M/A is cost-effective for preventing the transmission of spinal muscular atrophy to the offspring of carrier couples. These findings support insurance coverage of IVF with PGT-M/A for carriers of spinal muscular atrophy.

Keywords: Cost-effectiveness; IVF; PGTA; PGTM; Spinal muscular atrophy.

Fig. 1

Cost-effectiveness of IVF with PGT-M/A vs unassisted conception model diagram. The “M” process node is a Markov state transition that computes the annual parental healthcare costs including the costs of raising a child affected with SMA (if applicable) and the accumulated utility penalties over the simulated lifetime of the parent

Fig. 2

IVF with PGT-M/A cost model diagram. Success/failure of IVF defined as having retrieved eggs and then embryos available for PGT. Simulated patients undergo up to three IVF cycles and up to three embryo transfers per IVF cycle

Fig. 3

Acceptability curve for willingness-to-pay (WTP). At a WTP of $22,950, IVF with PGT-M/A becomes cost-effective compared to unassisted conception. At WTP above $50,000, IVF with PGT-M/A is cost-effective in 93.3% of the 10,000 model iterations. At WTP above $100,000, IVF with PGT-M/A is cost-effective in 99.5% of the 10,000 model iterations

Fig. 4

Incremental cost and effectiveness scatterplot showing all 10,000 model iterations. The circle delineates the 95% confidence region. IVF with PGT-M/A is more effective and more costly in all iterations. The willingness-to-pay (WTP) line plots the WTP as the slope of the line; all data points below/to the right of the line favor IVF with PGT-M/A as the cost-effective option while those above/to the left of the WTP line favor unassisted conception.