Cost-effectiveness analysis of uterus transplantation vs. gestational carrier for treatment of absolute uterine factor infertility in the United States.

OBJECTIVE

To compare the cost-effectiveness of treatment for patients with absolute uterine factor infertility to achieve one or two singleton births by gestational carrier vs. uterus transplant.

DESIGN

Decision analysis from the US healthcare sector perspective, with time horizons to achieve one or two singleton births.

SUBJECTS: Patients with uterine factor infertility desiring family building.

EXPOSURE: Gestational carrier or uterus transplant.

MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios, comparing the costs (2020 US Dollars) and effectiveness (quality-adjusted life years [QALYs] and live births) to achieve one or two births by gestational carrier vs. uterus transplant.

RESULTS

In the base case of one singleton birth, the overall cost using a gestational carrier was $97,712.90 ($56,985.20-$153,084.20) compared with $116,137.20 ($67,142.88-$182,290.86) after uterus transplant. Quality-adjusted life years were higher in the gestational carrier arm (0.93) compared with the uterus transplant (0.90) and overall rates of live birth were also higher in the gestational carrier arm (94%) compared with the uterus transplant arm (77%). Costs of the gestational carrier and uterus transplant recipient were the most significant cost variables in the model. Monte Carlo simulation showed that uterus transplant had a 37% chance of being the cost-effective strategy for a single live birth at a willingness to pay of $150,000/QALY. In the case of two singleton births, the cost using a gestational carrier was $186,278.56 ($103,597.81-$296,010.27) compared with $164,276.84 ($111,961.91-$229,394.43) after uterus transplant. Quality-adjusted life years were again higher in the gestational carrier arm (0.93) than the uterus transplant (0.89). Overall rates of two live births were also higher in the gestational carrier arm (86%) compared with the uterus transplant arm (66%). Monte Carlo simulation showed that uterine transplant has a 62% chance of being the cost-effective strategy for two live births at a willingness to pay $150,000/QALY.

CONCLUSION

In the United States, treatment of uterine factor infertility with a gestational carrier is likely the most cost-effective approach for patients delivering a single child. However, the absolute costs associated with uterus transplants were 14% less than a gestational carrier for those having two live singleton births.