Kosteneffektivitätsanalyse der Oozyten Kryokonservierung ohne medizinische Indikation im Sinne des Social Freezing im Deutschen Gesundheitssystem auf Basis eines Markov Modells

Fragestellung: Ist die Oozyten Kryokonservierung aus nicht medizinischer Indikation – das sogenannte „social freezing“ – in Deutschland auf Basis einer Modellrechnung aktuell kosteneffektiv im Vergleich zur herkömmlichen In-vitro-Fertilisation (IVF)/ intrazytoplasmatischen Spermieninjektion? Zusam...

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Bibliographic Details
Main Author: Klüber, Cosima Marlene
Contributors: Ziller, Volker (PD Dr. med) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2019
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Study question: Is oocyte freezing for non medical reasons so called “social freezing” (SF) cost effective compared to standard in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) in Germany today? Summary answer: There is a possibility of reaching higher live birth rates with oocyte cryopreservation compared to taking no action, but at a significantly higher cost per live birth. In none of the modeled scenarios was oocyte cryopreservation more cost effective than conventional artificial reproductiv e techniques (ART). What is known already: As female fertility declines with increasing age and the trend of women bearing their first child later in life continues the use of fertility preservation techniques such as freezing oocytes for non medical reas ons has increased worldwide. Although egg freezing has certain benefits, limited data about safety, efficacy and cost effectiveness are available. For reproductive experts these data are necessary for physicians as well as patients to provide balanced and well informed counselling Study design: We developed a model based on three strategies for women planning to postpone pregnancy until the age of 40. In each strategy women actively practiced contraception until 40 then tried to conceive naturally for one year. If unsuccessful, women using strategy I (oocyte cryopreservation) attempted a maximum of three cycles of ICSI with frozen oocytes collected at ages of 25, 28, 30, 35 and 38 in the second year while women using strategy II (no action) further att empted natural conception. In strategy III (IVF/ICSI) women underwent one year of IVF/ICSI with a maximum of three cycles of stimulation and embryo transfer. If still unsuccessful after the second year each strategy was followed by attempting natural conce ption again until 45. Materials, methods: We used an adaptive Markov model to estimate and compare cumulative five year live birth rates and cost effectiveness measures (costs per woman and per live birth) between the three strategies. Costs and chances of a pregnancy resulting in live birth after standard IVF/ICSI cycles, after ICSI with thawed oocytes and after attempting natural conception were all based on published data (e.g. German IVF Registry (DIR)). Main results and the role of chance: Fo r strategy I (oocyte freezing) cumulative live birth rates at age 45 generally declined with age at freezing and were in the range of 0.714 (25 Y) to 0.676 (38 Y), while the cumulative success rate was 0.515 for strategy II (no action) and 0.608 for (38 Y), while the cumulative success rate was 0.515 for strategy II (no action) and 0.608 for stratestrategy II (IVF/ICSI). For 100 women using strategy I and freezing oocytes at 25 Y, this would gy II (IVF/ICSI). For 100 women using strategy I and freezing oocytes at 25 Y, this would result in an estimated 6.8 to 10.6 additional live births compared to IVF/ICSI and 16.1 to 19.9 result in an estimated 6.8 to 10.6 additional live births compared to IVF/ICSI and 16.1 to 19.9 more compared to attempting natural conception alone. more compared to attempting natural conception alone. The costs of egg freezing per woman were ageg freezing per woman were age--dependent bedependent betweentween 17,512 € (25 Y), € (25 Y), andand 18,086 € (35 Y)(35 Y). . Costs per live birth followed a similar patterCosts per live birth followed a similar pattern. n. The costs for strategy III were lower at The costs for strategy III were lower at 12,338 € per women and 20,293 € per live birthper women and 20,293 € per live birth.. Limitations, reasons for caution: This study faces several limitations. Although the effects of This study faces several limitations. Although the effects of age on fertility have been widely studied, data on natural conception, especially for higher age on fertility have been widely studied, data on natural conception, especially for higher ages, are limited. The same is true for data on oocyte freezing, fertilization and pregnancy ages, are limited. The same is true for data on oocyte freezing, fertilization and pregnancy rates.rates. The results of the model could therefore vary under different assumptions. Also, lower The results of the model could therefore vary under different assumptions. Also, lower recall rates among patients using SF can significantly reduce costrecall rates among patients using SF can significantly reduce cost--effectiveness. Wider implications of the findings: Based on our results Based on our results ““social freezingsocial freezing”” in Germany may lead in Germany may lead to additional pregnancies among women over 40 but also to significantly higher costs, since to additional pregnancies among women over 40 but also to significantly higher costs, since given the current live birth success rates and pricing, given the current live birth success rates and pricing, ““social freezingsocial freezing”” does not appear to be does not appear to be cost effective. This should be taken into accoucost effective. This should be taken into account when counselling patients and should be nt when counselling patients and should be revaluated again in the future as newer data on success rates and changing costs becomes revaluated again in the future as newer data on success rates and changing costs becomes available.available.