Preimplantation genetic testing for BRCA gene mutation carriers: A cost effectiveness analysis (340)

Abstract

Objectives: To investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception. Methods: The cost-effectiveness of two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer versus natural conception with a 50% chance of BRCA positive newborn for BRCA mutation carriers, was compared using a Markovian process decision analysis model. Costs of the two strategies were compared using quality-adjusted life years (QALYs’). All costs were discounted by 3%. Incremental cost-effectiveness ratio (ICER) compared to the willingness to pay threshold was used for cost-effectiveness analysis. A probabilistic sensitivity analysis (Monte Carlo simulation) was conducted with all variables, using 100 trials, each included 10,000 couples, to evaluate model uncertainties. Results: IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate. Discount rate and uptake of risk reduction salpingo- oophorectomy (RRSO) are the most influential parameters that affect the ICER. Increasing uptake of RRSO would make the ICER highly cost-effective. Conclusions: IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is costeffective and may be offered for selected couples with high BRCA mutation-related morbidity or mortality. Our results could impact decisions regarding conception among BRCA positive couples and health care providers. Objectives: To investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception. Methods: The cost-effectiveness of two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer versus natural conception with a 50% chance of BRCA positive newborn for BRCA mutation carriers, was compared using a Markovian process decision analysis model. Costs of the two strategies were compared using quality-adjusted life years (QALYs’). All costs were discounted by 3%. Incremental cost-effectiveness ratio (ICER) compared to the willingness to pay threshold was used for cost-effectiveness analysis. A probabilistic sensitivity analysis (Monte Carlo simulation) was conducted with all variables, using 100 trials, each included 10,000 couples, to evaluate model uncertainties. Results: IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate. Discount rate and uptake of risk reduction salpingo- oophorectomy (RRSO) are the most influential parameters that affect the ICER. Increasing uptake of RRSO would make the ICER highly cost-effective. Conclusions: IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is costeffective and may be offered for selected couples with high BRCA mutation-related morbidity or mortality. Our results could impact decisions regarding conception among BRCA positive couples and health care providers.