{"id":121,"title":"Preimplantation genetic testing for aneuploidy (PGT-A) vs. morphology-based blastocyst selection for transfer: cost-effectiveness analysis within Israel's publicly funded IVF system","title_zh":"以色列公共资助IVF体系下PGT-A与形态学囊胚选择移植的成本效果分析","url":"https://pubmed.ncbi.nlm.nih.gov/42968124","doi":"10.1186/s13584-026-00790-z","pmid":"42968124","journal":"Isr J Health Policy Res","kind":"paper","lang":"en","published_at":"2026-11-02T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Zivi E","Leshno M","Hammerman A","Ziv-Baran T"],"primary_topic":"pgt","topics":[{"slug":"pgt","score":9.0,"hits":["embryo selection","pgt-a","preimplantation genetic"]},{"slug":"art-clinical","score":7.0,"hits":["assisted reproductive","in vitro fertilization","ivf","live birth"]},{"slug":"early-embryo","score":5.0,"hits":["blastocyst","blastocysts"]},{"slug":"industry","score":1.0,"hits":["reimbursement"]}],"topic_score":9.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":73.0,"final_score":78.0,"score_dims":{"novelty":65,"rigor":70,"impact":70,"relevance":90,"translation":75},"recommend_reason":"在完全公共资助IVF体系内评估PGT-A成本效果，结论对资助政策与临床取舍有直接参考价值；但属模型研究且高度依赖以色列本地成本结构，外推需谨慎。","keywords":["PGT-A","成本效果分析","囊胚形态学选择","公共资助IVF","马尔可夫模型","活产"],"selected":1,"story_id":202,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":2,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该研究从以色列公共医保支付方视角，用马尔可夫决策模型比较PGT-A与形态学囊胚选择在重复移植中的成本效果，效果指标为活产。成本取自以色列卫生部2025年数据，临床概率来自SART数据库，并做单因素敏感性分析。结果显示，不采用PGT-A策略占优：各年龄组和囊胚数场景下PGT-A成本更高且效果更低；检测单价与可用囊胚数是增量成本的主要影响因素。作者认为PGT-A不宜纳入以色列公共IVF资助，仅在检测成本降低时，可考虑用于高龄患者。","summary":"BACKGROUND: Israel operates one of the most extensive publicly funded in vitro fertilization (IVF) programs worldwide. Alongside IVF, adjunct technologies aimed at improving reproductive outcomes, such as preimplantation genetic testing for aneuploidy (PGT-A), have been increasingly adopted. PGT-A is designed to identify chromosomally normal embryos before transfer. Despite its growing use, PGT-A is not included in Israel's National Health Basket. Given the local high utilization of IVF and the substantial public expenditure, evaluating the economic value of PGT-A is essential for evidence-based health policy decision-making. Most available analyses of PGT-A originate from private or mixed healthcare systems, where treatment costs and reimbursement structures differ from Israel's fully publicly funded IVF model. This study aimed to determine whether PGT-A is cost-effective when provided as part of Israel's IVF program. METHODS: A theoretical model-based cost-effectiveness analysis using a Markov decision framework compared PGT-A with morphology-based embryo selection from the perspective of the Israeli public healthcare payer. The model simulated repeated embryo transfers for various age groups and blastocyst availability scenarios. Relevant cost estimates of the two strategies were based on Israeli Ministry of Health data (2025). The probabilities of main clinical outcomes were derived from the American Society for Assisted Reproductive Technology (SART) database. The effectiveness outcome was live birth. Deterministic one-way sensitivity analyses were performed. RESULTS: The cost-effectiveness analysis showed dominance for the no-PGT-A strategy; PGT-A was associated with higher costs and lower effectiveness compared with no-PGT-A. Across all age groups and blastocyst numbers, PGT-A was consistently more costly than no-PGT-A. Sensitivity analyses identified the cost of the PGT-A test per tested embryo and the number of available blastocysts as the most influential factors on the incremental cost. It was demonstrated that although PGT-A is a less effective strategy, reducing the costs of the PGT-A test could make it a less costly strategy for women aged 38 years and above. In this circumstance, a trade-off between strategies can be considered. CONCLUSIONS: PGT-A cannot be recommended for public funding within the Israeli public IVF program. Its application may be considered for advanced-age patients if the cost of the PGT-A test is reduced.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}