Preimplantation genetic testing for BRCA gene mutation carriers: a cost effectiveness analysis

Nadav Michaan,Shira Peleg-Hasson,Yoni Cohen,Tamar Safra,Moshe Leshno,Ido Laskov,Dan Grisaru

doi:10.1186/s12958-021-00827-9

Abstract

BackgroundGynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was 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.MethodsCost-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 at 3%. Incremental cost effectiveness ratio (ICER) compared to willingness to pay threshold was used for cost-effectiveness analysis.ResultsIVF/ 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.ConclusionsIVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is cost effective 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.

Highlights

Gynecologic oncologists should be aware of the option of conception through in-vitro fertilization (IVF)/preimplantation genetic testing for monogenic/single gene disorders (PGT-M) for families with high BRCA related morbidity or mortality
Delivering a BRCA negative newborn after IVF/ PGTM, compared to natural conception, is cost effective according to our model, with an Incremental cost effectiveness ratio (ICER) of 150,219 new Israeli Shekels (NIS) per quality adjusted life years (QALYs) gained, at a 3% discount rate compared to a willingness to pay threshold of 1–3 times Israeli gross national product (GNP) per capita, equivalent to 44,480 USD (Table 2)
As the money spent on IFV/ PGT-M is used at present, while screening strategies for BRCA carriers, risk reduction surgeries as well as breast and ovarian cancer treatments start many years later, discounting makes costs of future spending much lower than current values

Summary

Introduction

Gynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was to investigate the cost-effectiveness of preimplan‐ tation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception. Delivering a BRCA negative newborn would prevent the need for life long cancer surveillance for BRCA positive patients along with the medical, psychological and financial burden associated, and may be a suitable solution for some BRCA positive families. The aim of our study was to investigate whether IVF/ PGT-M for BRCA negative embryo selection among BRCA positive parents as opposed to natural conception with a 50% chance of a BRCA positive fetus, due to dominant gene inheritance, would be a cost effective strategy

Objectives

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Results

Conclusion