A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis

Objective: To perform a cost-benefit analysis of preimplantation genetic diagnosis (PGD) for carrier couples of cystic fibrosis (CF) compared with the alternative of natural conception (NC) followed by prenatal testing and termination of affected pregnancies. Design: Cost-benefit analysis using a decision analytic model. Setting: Outpatient reproductive health practices. Patient(s): A simulated cohort of 1,000 female patients. Intervention(s): We calculated the net benefit of giving birth to a child as the present value of lifetime earnings minus lifetime medical costs. Main Outcome Measure(s): Net benefits in dollars. Result(s): When used for women younger than 35 years of age, the net benefit of PGD over NC was $182,000 ($715,000 vs. $532,000, respectively). For women aged 35-40 years, the net benefit of PGD over NC was $114,000 ($634,000 vs. $520,000, respectively). For women older than 40 years, however, the net benefit of PGD over NC was -$148,000 ($302,000 vs. $450,000, respectively). Conclusion(s): Preimplantation genetic diagnosis provides net economic benefits when used by carrier couples of CF. Although there is an upper limit of maternal age at which economic benefit can be demonstrated, carrier couples of CF should be offered PGD for prevention of an affected child.