Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study

• Published in: Journal of assisted reproduction and genetics Vol. 38; no. 9; pp. 2435 - 2443
• Main Authors: Chung, Esther H., Lim, Stephanie L., Myers, Evan, Moss, Haley A., Acharya, Kelly S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2021; Springer Nature B.V
• Subjects: Adult; Chemotherapy; Cost analysis; Cost-Benefit Analysis - methods; Cryopreservation; Cryopreservation - economics; Female; Fertility; Fertility Preservation; Fertility Preservation - economics; Gynecology; Human Genetics; Humans; Infertility, Female - economics; Infertility, Female - pathology; Infertility, Female - therapy; Laparoscopy; Medicine; Medicine & Public Health; Neoplasms - physiopathology; Oocyte Retrieval; Oocytes - cytology; Ovaries; Ovary - cytology; Pregnancy; Reproductive health; Reproductive Medicine; Sensitivity analysis; Ovarian tissue cryopreservation; Fertility preservation; Oncofertility; Cost-effectiveness; Oocyte cryopreservation
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-021-02222-0

Purpose In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an alternative to oocyte cryopreservation (OC) for women receiving gonadotoxic therapy. Anticipating increased use of OTC, we compare the cost-effectiveness of OC versus OTC for fertility preservation in oncofertility patients. Methods A cost-effectiveness model to compare OC versus OTC was built from a payer perspective. Costs and probabilities were derived from the literature. The primary outcome for effectiveness was the percentage of patients who achieved live birth. Strategies were compared using incremental cost-effectiveness ratios (ICER). All inputs were varied widely in sensitivity analyses. Results In the base case, the estimated cost for OC was $16,588 and for OTC $10,032, with 1.56% achieving live birth after OC, and 1.0% after OTC. OC was more costly but more effective than OTC, with an ICER of $1,163,954 per live birth. In sensitivity analyses, OC was less expensive than OTC if utilization was greater than 63%, cost of OC prior to chemotherapy was less than $8100, cost of laparoscopy was greater than $13,700, or standardized discounted costs were used. Conclusions With current published prices and utilization, OC is more costly but more effective than OTC. OC becomes cost-saving with increased utilization, when cost of OC prior to chemotherapy is markedly low, cost of laparoscopy is high, or standardized discounted oncofertility pricing is assumed. We identify the critical thresholds of OC and OTC that should be met to deliver more cost-effective care for oncofertility patients.