AVERAGE COST OF IN VITRO FERTILIZATION WITH PREIMPLANTATION GENETIC TESTING FOR MONOGENIC DISORDERS AND ANEUPLOIDY PER UNAFFECTED LIVE BIRTH FOR CARRIER COUPLES

Abstract

To determine the average cost of in vitro fertilization (IVF) with preimplantation genetic testing for monogenic disorders and aneuploidy (PGT-M/A) per unaffected live birth for carrier couples. We constructed a Markov state-transition model to simulate patients undergoing IVF with PGT-M/A. Patients were simulated to undergo up to 3 IVF cycles with up to 3 embryo transfers per cycle. IVF outcome data from 76 carriers of a variety of monogenic disorders who underwent PGT-M/A at a single academic REI center was used to determine the probabilities of having at least 1, 2, and 3 unaffected embryos. This data was stratified by age (<35 and 35+) and a separate model was utilized for each age group. Only euploid unaffected embryos were assumed to be transferred; euploid carrier embryos were considered affected. All spontaneous losses were assumed to undergo dilation & curettage (D&C). Additional probabilities derived from peer-reviewed literature included successful egg retrieval, embryos available for biopsy, clinical pregnancy, and spontaneous loss. Costs (2021 US$, healthcare perspective) for IVF, PGT-M/A, embryo biopsy, embryo transfer, and D&C were derived from peer-reviewed literature. Only direct healthcare-related costs were considered, and routine prenatal costs were omitted. A discrete Monte Carlo simulation was performed to simulate 10,000 patients through the model and a probabilistic sensitivity analysis (PSA) was also performed to assess the model’s integrity. For patients below the age of 35, the average cost to have an unaffected live birth using IVF with PGT-M/A was $30,086 (PSA SD $4,338, max $46,636), while the average cost for those 35 and older was $31,418 (PSA SD $4,700, max $47,850). On average, couples who are carriers of monogenic disorders can be expected to pay approximately $30,000 to have an unaffected child using IVF and PGT-M/A.