Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data

• Published in: Applied health economics and health policy 2016-06, Vol.14 (3), p.387-395
• Main Authors: Carpinello, Olivia J., Casson, Peter R., Kuo, Chia-Ling, Raj, Renju S., Sills, E. Scott, Jones, Christopher A.
• Format: Article
• Language: English
• Subjects: Adult; Babies; Birth rate; Birth weight; Cesarean section; Cognition & reasoning; Conflicts of interest; Cost analysis; Cost-Benefit Analysis; Developmental Disabilities - economics; Developmental Disabilities - epidemiology; Developmental Disabilities - etiology; Disposable income; Embryo Transfer - adverse effects; Embryo Transfer - economics; Embryo Transfer - statistics & numerical data; Embryos; Female; Fertilization in Vitro - adverse effects; Fertilization in Vitro - economics; Fertilization in Vitro - methods; Fetuses; Gestational Age; Health Administration; Health care; Health Care Costs; Health care expenditures; Health Economics; Health risk assessment; Hospital costs; Humans; In vitro fertilization; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infants; Infertility; Insurance coverage; Maternal Age; Medicine; Medicine & Public Health; Monte Carlo Method; Mortality; Multiple births; Original Research Article; Patients; Pharmacoeconomics and Health Outcomes; Pregnancy; Pregnancy Outcome - economics; Pregnancy Outcome - epidemiology; Pregnancy, Multiple; Premature babies; Premature birth; Public Health; Quality of Life Research; Vermont - epidemiology
• ISSN: 1175-5652; 1179-1896
• DOI: 10.1007/s40258-016-0237-2

Background In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes. Objective To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth. Methods Medical records of patients who conceived with IVF ( n  = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated. Results The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively. Conclusion Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.