COST-EFFECTIVENESS OF A PUBLICLY FUNDED ELECTIVE EGG FREEZING PROGRAM FOR WOMEN DELAYING CHILDBEARING IN GERMANY
Author(s)
Anita J. Brogan, MSc, PhD1, Ashley Lee, Ph.D.1, Stuart Lavery, MBBS2, Holger Aust, Ph.D.3, Markus Kimmel, Ph.D.4, Jan-Steffen Kruessel, Ph.D.5, Andreas Tandler-Schneider, Ph.D.6, Kemal Uca, MBA7, Juan Enrique Schwarze, MSc, MD7, Claudia Roeder, Ph.D.7.
1AESARA, San Diego, CA, USA, 2University College Hospitals NHS Foundation Trust, London, United Kingdom, 3Databraineo, Netherlands, Netherlands, 4Deutsches IVF-Register e.V. (D·I·R), Düsseldorf, Germany, 5UniKiD Center for Reproductive Medicine, Düsseldorf, Germany, 6Fertility Center Berlin, Berlin, Germany, 7Merck Healthcare KGaA, Darmstadt, Germany.
1AESARA, San Diego, CA, USA, 2University College Hospitals NHS Foundation Trust, London, United Kingdom, 3Databraineo, Netherlands, Netherlands, 4Deutsches IVF-Register e.V. (D·I·R), Düsseldorf, Germany, 5UniKiD Center for Reproductive Medicine, Düsseldorf, Germany, 6Fertility Center Berlin, Berlin, Germany, 7Merck Healthcare KGaA, Darmstadt, Germany.
OBJECTIVES: Women increasingly delay childbearing for financial, professional, or personal reasons, potentially limiting family-building opportunities. Elective egg freezing (EEF) allows oocyte cryopreservation at a reproductively optimal age, potentially improving future live birth (LB) outcomes. This analysis evaluated the cost-effectiveness of a public EEF program versus no EEF for women delaying childbearing, from a German healthcare perspective.
METHODS: A decision-tree model was developed comparing EEF versus no EEF. In the EEF arm, women (25-34 years) underwent one ovarian stimulation (OS) and oocyte retrieval cycle with oocytes cryopreserved for future use. In both arms, women attempted natural conception at 40 years; those without a LB proceeded to assisted reproductive technology (ART) at age 41. ART in the EEF arm included up to five embryo transfer cycles using thawed oocytes; ART in the no EEF arm included up to four OS cycles with up to five embryo transfers per cycle. Model inputs were derived from the Deutsches IVF-Register (D·I·R), the German statutory health insurance outpatient fee schedule (EBM/KBV), and other published and publicly available sources. Costs were discounted at 4% annually. Parameter uncertainty and modelling assumptions were assessed using probabilistic and deterministic sensitivity analyses and scenario testing.
RESULTS: EEF was associated with 64% more LBs versus no EEF (45 vs 27 per 100 women) driven by higher ART-related LBs (27 vs 9). Total discounted costs were higher with EEF (€6,203 vs €4,455 per woman), but costs per LB were lower (€13,875 vs €16,339). At a willingness-to-pay threshold of €30,000/LB, EEF was cost-effective with an incremental cost of €10,021 per additional LB. Results were robust in sensitivity and scenario analyses.
CONCLUSIONS: From the German healthcare perspective, EEF is a cost-effective strategy compared with no EEF for improving LBs outcomes among women delaying childbearing, supporting the establishment of a publicly funded EEF program in Germany.
METHODS: A decision-tree model was developed comparing EEF versus no EEF. In the EEF arm, women (25-34 years) underwent one ovarian stimulation (OS) and oocyte retrieval cycle with oocytes cryopreserved for future use. In both arms, women attempted natural conception at 40 years; those without a LB proceeded to assisted reproductive technology (ART) at age 41. ART in the EEF arm included up to five embryo transfer cycles using thawed oocytes; ART in the no EEF arm included up to four OS cycles with up to five embryo transfers per cycle. Model inputs were derived from the Deutsches IVF-Register (D·I·R), the German statutory health insurance outpatient fee schedule (EBM/KBV), and other published and publicly available sources. Costs were discounted at 4% annually. Parameter uncertainty and modelling assumptions were assessed using probabilistic and deterministic sensitivity analyses and scenario testing.
RESULTS: EEF was associated with 64% more LBs versus no EEF (45 vs 27 per 100 women) driven by higher ART-related LBs (27 vs 9). Total discounted costs were higher with EEF (€6,203 vs €4,455 per woman), but costs per LB were lower (€13,875 vs €16,339). At a willingness-to-pay threshold of €30,000/LB, EEF was cost-effective with an incremental cost of €10,021 per additional LB. Results were robust in sensitivity and scenario analyses.
CONCLUSIONS: From the German healthcare perspective, EEF is a cost-effective strategy compared with no EEF for improving LBs outcomes among women delaying childbearing, supporting the establishment of a publicly funded EEF program in Germany.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
P21
Topic
Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Reproductive & Sexual Health