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Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization.

Publication ,  Journal Article
Chung, EH; Lim, SL; Havrilesky, LJ; Steiner, AZ; Dotters-Katz, SK
Published in: Ultrasound Obstet Gynecol
June 2021

OBJECTIVES: To determine if a policy of universal fetal echocardiography (echo) in pregnancies conceived by in-vitro fertilization (IVF) is cost-effective as a screening strategy for congenital heart defects (CHDs) and to examine the cost-effectiveness of various other CHD screening strategies in IVF pregnancies. METHODS: A decision-analysis model was designed from a societal perspective with respect to the obstetric patient, to compare the cost-effectiveness of three screening strategies: (1) anatomic ultrasound (US): selective fetal echo following abnormal cardiac findings on detailed anatomic survey; (2) intracytoplasmic sperm injection (ICSI) only: fetal echo for all pregnancies following IVF with ICSI; (3) all IVF: fetal echo for all IVF pregnancies. The model initiated at conception and had a time horizon of 1 year post-delivery. The sensitivities and specificities for each strategy, the probabilities of major and minor CHDs and all other clinical estimates were derived from the literature. Costs, including imaging, consults, surgeries and caregiver productivity losses, were derived from the literature and Medicare databases, and are expressed in USA dollars ($). Effectiveness was quantified as quality-adjusted life years (QALYs), based on how the strategies would affect the quality of life of the obstetric patient. Secondary effectiveness was quantified as number of cases of CHD and, specifically, cases of major CHD, detected. RESULTS: The average base-case cost of each strategy was as follows: anatomic US, $8119; ICSI only, $8408; and all IVF, $8560. The effectiveness of each strategy was as follows: anatomic US, 1.74487 QALYs; ICSI only, 1.74497 QALYs; and all IVF, 1.74499 QALYs. The ICSI-only strategy had an incremental cost-effectiveness ratio (ICER) of $2 840 494 per additional QALY gained when compared to the anatomic-US strategy, and the all-IVF strategy had an ICER of $5 692 457 per additional QALY when compared with the ICSI-only strategy. Both ICERs exceeded considerably the standard willingness-to-pay threshold of $50 000-$100 000 per QALY. In a secondary analysis, the ICSI-only strategy had an ICER of $527 562 per additional case of major CHD detected when compared to the anatomic-US strategy. All IVF had an ICER of $790 510 per case of major CHD detected when compared with ICSI only. It was determined that it would cost society five times more to detect one additional major CHD through intensive screening of all IVF pregnancies than it would cost to pay for the neonate's first year of care. CONCLUSION: The most cost-effective method of screening for CHDs in pregnancies following IVF, either with or without ICSI, is to perform a fetal echo only when abnormal cardiac findings are noted on the detailed anatomy scan. Performing routine fetal echo for all IVF pregnancies is not cost-effective. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

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Published In

Ultrasound Obstet Gynecol

DOI

EISSN

1469-0705

Publication Date

June 2021

Volume

57

Issue

6

Start / End Page

979 / 986

Location

England

Related Subject Headings

  • United States
  • Ultrasonography, Prenatal
  • Sperm Injections, Intracytoplasmic
  • Quality of Life
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Humans
  • Heart Defects, Congenital
  • Fertilization in Vitro
  • Female
 

Citation

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Chung, E. H., Lim, S. L., Havrilesky, L. J., Steiner, A. Z., & Dotters-Katz, S. K. (2021). Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization. Ultrasound Obstet Gynecol, 57(6), 979–986. https://doi.org/10.1002/uog.22048
Chung, E. H., S. L. Lim, L. J. Havrilesky, A. Z. Steiner, and S. K. Dotters-Katz. “Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization.Ultrasound Obstet Gynecol 57, no. 6 (June 2021): 979–86. https://doi.org/10.1002/uog.22048.
Chung EH, Lim SL, Havrilesky LJ, Steiner AZ, Dotters-Katz SK. Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization. Ultrasound Obstet Gynecol. 2021 Jun;57(6):979–86.
Chung, E. H., et al. “Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization.Ultrasound Obstet Gynecol, vol. 57, no. 6, June 2021, pp. 979–86. Pubmed, doi:10.1002/uog.22048.
Chung EH, Lim SL, Havrilesky LJ, Steiner AZ, Dotters-Katz SK. Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization. Ultrasound Obstet Gynecol. 2021 Jun;57(6):979–986.
Journal cover image

Published In

Ultrasound Obstet Gynecol

DOI

EISSN

1469-0705

Publication Date

June 2021

Volume

57

Issue

6

Start / End Page

979 / 986

Location

England

Related Subject Headings

  • United States
  • Ultrasonography, Prenatal
  • Sperm Injections, Intracytoplasmic
  • Quality of Life
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Humans
  • Heart Defects, Congenital
  • Fertilization in Vitro
  • Female