Cost-effectiveness of cytogenetic evaluation of products of conception by chorionic villous sampling in recurrent miscarriage†

Objective To compare the cost-effectiveness of performing chorionic villous sampling (CVS) of products of conception (POC) in the evaluation of recurrent miscarriage versus standard evidence based work-up (EBW) of the couple. Material and methods A Decision-analytic model was performed in couples with a third miscarriage. Three strategies were considered: 1)the standard EBW of all the patients: comprising parental karyotype, uterine cavity assessment and antiphospholipid antibodies. 2) performing a CVS of POC and a standard karyotype, and if euploid, follow with EBW. 3) performing a CVS of POC and an arrayCGH and if normal, follow with EBW. Estimated cost and diagnostic yield of each strategy was analyzed. Sensitivity analysis and threshold cost were considered. Results The expected cost-effectiveness of CVS and karyotype of POC in recurrent miscarriage was: US$ 769,79 versus US$ 1361.8 for the standard EBW of the couple. When stratified by maternal age the results remained cost-effective for this strategy. The arrayCGH strategy has a higher diagnostic yield, but still expensive in our setting to be considered cost-effective. Conclusions Chorionic villous sampling and karyotype analysis of products of conception in a third miscarriage proved a more cost-effective strategy than standard evidence based workup of the couple. This article is protected by copyright. All rights reserved.