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

Area of Science:

• Reproductive Medicine
• Oncology
• Health Economics

Background:

• BRCA mutations significantly increase cancer morbidity and mortality.
• Gynecologic oncologists should consider advanced reproductive options for affected families.
• Preimplantation genetic testing for monogenic diseases (PGT-M) offers a pathway for BRCA carriers.

Purpose of the Study:

• To evaluate the cost-effectiveness of IVF/PGT-M for selecting BRCA-negative embryos.
• To compare this strategy against natural conception in BRCA mutation carriers.

Main Methods:

• A Markovian decision analysis model was employed.
• Cost-effectiveness was assessed using quality-adjusted life years (QALYs).
• Incremental cost-effectiveness ratio (ICER) was calculated and compared to willingness-to-pay thresholds.

Main Results:

• IVF/PGT-M with BRCA-negative embryo selection is cost-effective.
• The ICER was 150,219 new Israeli Shekels (approx. $44,480 USD) per QALY gained.
• A 3% discount rate was applied to all costs.

Conclusions:

• IVF/PGT-M and BRCA-negative embryo transfer is a cost-effective strategy for BRCA mutation carriers.
• This option may be suitable for selected couples with high BRCA-related risks.
• Findings can inform conception decisions for BRCA-positive couples and healthcare providers.