Value of PGT-A when only one or two blastocysts are obtained: propensity-score matching and cost-effectiveness study.

IF 6.1 1区医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2025-01-01 Epub Date: 2024-12-07 DOI:10.1002/uog.29148

D Cimadomo, M Taggi, V Cimadomo, F Innocenti, L Albricci, S Colamaria, C Argento, M Giuliani, S Ferrero, A Borini, M Guido, M R Campitiello, F M Ubaldi, A Capalbo, L Rienzi, G Gennarelli, A Vaiarelli

{"title":"Value of PGT-A when only one or two blastocysts are obtained: propensity-score matching and cost-effectiveness study.","authors":"D Cimadomo, M Taggi, V Cimadomo, F Innocenti, L Albricci, S Colamaria, C Argento, M Giuliani, S Ferrero, A Borini, M Guido, M R Campitiello, F M Ubaldi, A Capalbo, L Rienzi, G Gennarelli, A Vaiarelli","doi":"10.1002/uog.29148","DOIUrl":null,"url":null,"abstract":"Objective: To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained.Methods: A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER).Results: More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained.Conclusions: When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"106-113"},"PeriodicalIF":6.1000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ultrasound in Obstetrics & Gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/uog.29148","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ACOUSTICS","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained.

Methods: A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER).

Results: More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained.

Conclusions: When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

仅获得一个或两个囊胚时PGT-A的价值：倾向-评分匹配和成本-效果研究。

目的：比较非整倍体（PGT-A）仅获得1个囊胚和2个囊胚时体外受精（IVF）进行植入前基因检测和不进行植入前基因检测的效果和成本。方法：从2013年4月至2022年7月收集了1829例患者的数据集，包括368例非PGT-A和1461例PGT-A周期，获得了一个或两个囊胚。根据产妇年龄、受精中期卵母细胞数和获得囊胚数进行1:1的倾向评分匹配，每组242例患者。比较非PGT-A组和PGT-A组在每次胚胎移植（ET）的活产率（LBR）、每位患者的累积LBR、每次临床妊娠的流产率（MR）、卵母细胞取出和IVF周期结束之间的天数（主要结局）、临床平均费用和增量成本-效果比（ICER）方面的差异。结果：与PGT-A组相比，非PGT-A组进行的et数量是PGT-A组的两倍多，但两组之间每位患者的累积LBR相似(23.6% （95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)）。在PGT-A组中，每ET的LBR更高(16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)，每次临床妊娠的MR更低(30.1% （95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)）。PGT-A组每位患者的MR也较低(9.5% （95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)）。非PGT-A组从卵母细胞取出到IVF周期结束的平均时间为131 （95% CI, 113-150）天，而PGT-A组为74 （95% CI, 61-87）天。(P结论：当在专家IVF诊所对需要该手术的患者进行该手术时，即使只获得一个或两个囊胚，PGT-A也具有临床价值。PGT-A减少了et和流产的数量，而每位患者的累积LBR不受影响，并允许在更短的时间内实现这些结果。PGT-A与非PGT-A的ICER随着母亲年龄的增加而降低。©2024国际妇产科超声学会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.