In vitro fertilization with preimplantation genetic testing compared with donor sperm and natural conception among male Robertsonian translocation carriers: a cost-effectiveness analysis.

OBJECTIVE

To investigate the cost-effectiveness of reproductive strategies for male carriers of Robertsonian translocations.

DESIGN

We designed a model to compare the outcomes and costs of three strategies: in vitro fertilization with preimplantation genetic testing for structural rearrangements (IVF PGT-SR), frozen donor sperm intrauterine insemination, and natural conception. The model was built using a Markov process to simulate one year of clinical care (up to 3 cycles of IVF, 6 intrauterine inseminations, or 12 attempts at natural conception), incorporating delays between cycles for adverse outcomes.

SUBJECTS: Theoretical cohort of 2,751, an estimate of men aged 15-49 diagnosed with subfertility or nonsurgical sterility that are carriers of the most common Robertsonian translocation (13;14), within couples with fertility intention in one year.

EXPOSURE: Reproductive strategy selection (IVF PGT-SR, donor sperm, natural conception).

MAIN OUTCOME MEASURES: Outcomes included cost and quality-adjusted life years (QALYs) for the parents in addition to secondary outcomes of live births and decreased miscarriages, stillbirths, Trisomy 13 diagnoses, terminations, and neonatal deaths. A willingness-to-pay threshold was set at $100,000/QALY.

RESULTS

Compared with natural conception, donor sperm and IVF PGT-SR increased overall live births and decreased miscarriages, stillbirths, Trisomy 13 diagnoses, terminations, and neonatal deaths, albeit at a higher cost. Using donor sperm vs. IVF PGT-SR resulted in cost savings with modest reductions in poor outcomes. Both alternative strategies to natural conception were cost-effective. Donor sperm and IVF PGT-SR yielded incremental cost-effectiveness ratios of $2,019 per QALY and $8,469 per QALY compared with natural conception, respectively. Utilizing IVF PGT-SR vs. donor sperm was not cost-effective with an incremental cost-effectiveness ratio of $722,138 per QALY. However, in sensitivity analysis, IVF PGT-SR became cost-effective over donor sperm when the utility of non-biological progeny was less than 0.99.

CONCLUSION

For male rob(13;14) carriers, mother and offspring outcomes are improved with donor sperm and IVF PGT-SR. Utilizing donor sperm is a cost-effective conception strategy compared with both natural conception and IVF PGT-SR. For individuals strongly preferring biological progeny, IVF PGT-SR is cost-effective over donor sperm.