Cost-Effectiveness of CCS + eSET
Fewer multiples after single embryo transfer and Comprehensive Chromosome Screening (CCS) is a clear benefit, but does it make IVF less cost-effective overall?
Researchers from New Jersey recently explored this very question. They compared the overall costs of CCS and chromosomally normal (euploid) single embryo transfers (SETs) with SETs of unscreened embryos.1 Understanding these cost comparisons is important, especially given that the cumulative live birth rate per stimulation cycle is the same for both types of cycles.
The mathematical model. The researchers created a mathematical model to determine the average number of unscreened SET cycles required to produce either a live birth or to exhaust all embryos produced from a single retrieval. Based on actual outcome data, they assumed a baseline fresh embryo transfer rate of 30 percent for unscreened SETs.
The model assumed that all CCS transfers occurred in a subsequent frozen embryo transfer (FET) cycle and that all transfers in CCS cases would be euploid. In cases where all embryos were aneuploid, CCS obviously added cost, but did not add expenses related to transfer.
The researchers applied their outcome model to a database of patients younger than 42 whose CCS cycles were referred to a genetics laboratory between January of 2011 and March of 2016.
Potential costs. Using publicly available estimates, the researchers generated potential costs including:
- Fresh embryo transfer ($1,050)
- Embryo biopsy ($1,000)
- CCS ($2,000)
- Initial vitrification fee ($1,000)
- Subsequent FET cycles ($3,812)
How expensive? In the unscreened group, it took an estimated 25,179 embryo transfers to achieve either pregnancy or to use all embryos. This number was 9,750 in the CCS group, making the average overall cost to achieve one of the two endpoints higher in the unscreened sequential SET group ($7,972.80) than the CCS group ($7,137.99).
1. Neal S et al. Single Embryo Transfer (SET) Following Comprehensive Chromosome Screening (CCS) Is More Cost Effective Than Unscreened Sequential Set. Presented October 17, 2016, at ASRM 2016 Scientific Congress & Expo.