Main findings
subfertility, miscarriage
MISCARRIAGE
To our knowledge, this is the first study that revealed the cost-effectiveness of PGT-A in the Chinese healthcare system settings. This study showed that patients aged 20 to 37 years of old with fertility problems undergoing PGT-A (with cryopreservation and subsequent frozen embryo transfer cycles) contributed to an average of ¥ 5643.06 more per live birth. The addition of PGT‑A led to an increase in the costs of IVF treatment.More women in the conventional-IVF group underwent a second or third embryo-transfer cycle. Thus, the average costs of the two groups are not as different as expected. However, this differential did not translate into a higher CLBR and less direct medical costs for patients. From the healthcare system’s perspective, the findings of this cost-effectiveness analysis showed that PGT‑A could significantly lead to higher costs per patient. With the CLBR as the primary goal, conventional-IVF in infertile patients aged 20 to 37 years of age was the optimal treatment strategy.According to the annual report of assisted reproductive technology of the Chinese Society of Reproductive Medicine [In this model, we conclude that PGT-A was not a cost-effective tool to increase the number of live births in the population. We recommend the conventional-IVF as a suitable solution for patients who are not sensitive to the miscarriage cost, as this option could ensure patients meet the best cost-effectiveness. Our findings demonstrate that pursuing the advanced PGT-A functions is not related to better live birth outcomes and lower economic burden from the patients’ perspective. The findings are in line with the results of previous studies which focused on the subfertility patients with PGT-A in Germany and the USA [On the other hand, the ICER for miscarriage prevention was ¥45600.23. It represents the prevention of one miscarriage is a rather high cost, which is beyond most patients’ willingness to pay. In the Chinese context, WTP for 1 year of life or quality-adjusted life is commonly set somewhere between 1 and 3 times GDP per capita, but that WTP range is difficult to translate. Specific WTP guidelines for miscarriage prevention remain an evidence gap in the field. The probabilistic sensitivity analysis showed that the probability of PGT-A was dominant is 50.00% for miscarriage prevention when the threshold of willingness to pay was ¥ 43422.60. There are pros and cons to calculate cost-effectiveness with the threshold of averting miscarriage or increasing live birth [Reproductive experts and policy-makers in German believed that moderate copayment IVF technology is acceptable, and private insurance alone was not sufficient [