Preimplantation genetic testing for aneuploidy (PGT-A) vs. morphology-based blastocyst selection for transfer: cost-effectiveness analysis within Israel’s publicly funded IVF system

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.