Assistive Reproductive Technologies: A Literature Review and ...

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n Search ResultsThere were 811 published documents identified from the literature search (seeAppendix A for the search strategy, study selection, and data extraction). Afterreviewing their titles and abstracts, 110 studies were retrieved for further evaluation.Of the 110 studies, 18 met the final inclusion/exclusion criteria. Seven studies wererelated to the association between ARTs and increased health services costs andeleven were related to reducing the number of embryo transfers.n Evidence from Published LiteratureCost impact of ARTs on the health care systemKoivurova et al. 6 conducted a retrospective observational study comparing postneonatalhospital costs between IVF/ICSI children and matched controls forsingleton, twin, triplet, and quadruplet births (refer to Appendix B). Data wascollected from the Finnish Hospital Discharge Register and for each child inthe study included cost data from birth until 7 years of age. The costing wasconducted from a payer’s perspective and costs were expressed in 2004 Euros.Results indicate that compared to controls, IVF children had a significantlyhigher number of admissions to hospital on average (1.76 vs. 1.07) and a longeraverage length of stay (4.31 vs. 1.07). Costs of IVF children were 2.6 times greaterthan controls (€205.8 vs. €79.6 per child). However, the higher costs associatedwith IVF children were driven by comparisons between singleton births (i.e. IVFsingleton vs. natural singleton). No statistically significant findings were foundbetween IVF twin births and control twin births. In fact, IVF twin births hadlower costs than their matched controls. Limitations with the study were thatit did not include other relevant costs (e.g. ambulatory care and primary careutilization including physician visit costs), lack of sensitivity analysis, and did notindicate whether they used discounting to standardized costs to 2004. Theseresults suggest that ARTs singletons are associated with higher hospital costs thannaturally conceived singletons.Chambers et al. 7 conducted a retrospective observational study comparingaverage inpatient hospital costs between ARTs and non-ARTs singletons, twins,and HOMs of both infants and mothers. Specifically, cost comparisons weremade between ART singletons, twins, and HOMs with non-ART counterpartsand between ART singletons, twins, and HOMs. The ART study population wasderived from the Australian and New Zealand Assisted Reproductive Databasewhich collects information on all ARTs treatment cycles, including perinataloutcomes in Australia and New Zealand (5005 mothers who gave birth to 5886live born infants conceived following ARTs in 2003). The non-ART populationwas sourced from the Australian National Perinatal data collection which is across sectional database of all births in Australia including perinatal outcomes(250,254 mothers who gave birth to 254,425 live born infants conceived4 Assistive Reproductive Technologies:a Literature Review and Database Analysis
naturally in 2003). Cost data was derived from the National Hospital MorbidityDatabase of women who gave birth in Australia in 2003 and is expressed in2003 Australian dollars converted to Euros. The costing was conducted froma payer’s perspective. Results indicate that ARTs infants were 4.4 times morelikely to be of LBW (< 2500g) and five times more likely to be of very LBW(< 1500g) compared to non-ARTs infants. Compared to non-ARTs infants,the inpatient costs were €1330 higher for ARTs infants (€2832 vs. €1502). Formothers, maternal costs for ARTs singletons, twins, and HOM were 11%, 6%,and 8% higher than their non-ARTs counterparts respectively with overall 23%higher birth admissions cost (€3321 vs. €2708). The overall cost of all ARTs birthepisodes regardless of plurality was 57% higher than non-ARTs birth episodes.When comparing plurality within ARTs birth episodes, twin (€13,890) and HOM(€54,294) costs were three and 11 times higher than singletons (€4818). Theauthors report that approximately €9.2 million could be saved in birth admissionsalone if ARTs multiples had been singleton births. The authors concluded thatthe results highlight the need for policies supporting single embryo transfer.Strengths of the study were that it conducted a sensitivity analysis and athorough costing analysis. Limitations of the study were that it only focused oninpatient costs (e.g. mothers of twins and HOM may utilize greater ambulatoryand primary care services). Nevertheless, the study provides a direct link betweenARTs related births and increased costs to the health care system.Ledger et al. 8 used a decision analytic model (DAM) to compare maternal andneonatal costs of IVF multiple pregnancies and IVF singleton pregnancies. Datawas collected from the United Kingdom national statistics database between April1, 2000 and March 31, 2001 and included total number of births resulting from IVFtreatment and cost data from pregnancy until one year of age. The IVF populationconsisted of 4621 singletons, 1579 twins and 109 triplets. The costs of infertilitytreatment were excluded as they were common to all study groups. The costingwas conducted from a payer’s perspective and costs were expressed in 2002 BritishPounds. Results indicate that total direct costs per IVF pregnancy were £3313 forsingletons, £9122 for twins, and £32,354 for triplets. IVF multiple pregnanciesaccounted for 1/3 of the total annual number of maternities but generated 56%of the total costs associated with IVF pregnancies. The authors concluded thatIVF multiple pregnancies are associated with significantly higher costs than IVFsingletons and thus, there is potential cost savings associated with SET policies.Limitations of the study were that it did not consider long term health and costsoutcomes and that costs for antenatal care, outpatient visits, and postnatal homevisits for twins and triplets were assumed to be the same for the singleton.Cassell et al. 9 conducted a retrospective observational study comparing hospitalcosts between singleton, twin, and HOM pregnancies in Nova Scotia. Data wascollected from a tertiary maternal hospital and the Nova Scotia Atlee PerinatalDatabase. Between January 1980 and December 2001 there were 113,222singleton pregnancies, 1724 twin pregnancies, and 37 HOM pregnancies.Hospital costs were calculated based on maternal and neonatal length of stay.Assistive Reproductive Technologies:a Literature Review and Database Analysis 5
Page 1 and 2: IHE ReportAssistive ReproductiveTec
Page 3 and 4: n Assistive Reproductive Technologi
Page 5 and 6: Executive Summaryn ObjectivesThis r
Page 7 and 8: n ConclusionsBased on the evidence
Page 9 and 10: Table of ContentsAcknowledgementsEx
Page 11 and 12: n Background to Technology ReviewAs
Page 13: Section 1: Review of Economic Studi
Page 17 and 18: vs. €13,469). The authors conclud
Page 19 and 20: IVF in Ontario are greater than the
Page 21 and 22: Cost impact of providing insurance
Page 23 and 24: the analysis had a relatively short
Page 25 and 26: Section 2: Preliminary Analyses of
Page 27 and 28: Table 2-A: Summary of statistical a
Page 29 and 30: DescriptiveThere were 36,158 mother
Page 31 and 32: Table 2-D: Probability of LBW by pl
Page 33 and 34: Figure 2-B shows the predicted hosp
Page 35 and 36: Figure 2-C: Linear prediction of in
Page 37 and 38: Figure 2-E shows the total costs an
Page 39 and 40: Caveats and Limitations of Current
Page 41 and 42: 5. Greene C, Lange I. The Assisted
Page 43 and 44: Appendix A: Search Strategyn Genera
Page 45 and 46: DatabaseWeb of ScienceISI Interface
Page 47 and 48: Data ExtractionExtracted data from
Page 49 and 50: Results Study Conclusions Evidence
Page 57 and 58: Table B-1: Hospital, physician, and
Page 59 and 60: Trimming Outliers 2×SDInfant HospV
Page 61 and 62: Dropped by 2*SDInfant Hosp Costs --
Page 63 and 64: Figure B-2: Scatterplot of mother h
Page 65 and 66:
Mother Hosp Costs----Trimmed data0
Page 67 and 68:
Dropped by 2*SDInfant Hosp Costs (t
Page 69 and 70:
Figure B-4: Scatterplot of mother h
Page 71 and 72:
Dropped by 3*SDMother Hosp Costs (t
Page 73 and 74:
Infant Hosp Costs (Excluding Outlie
Page 75 and 76:
Infant Hosp Costs (Excluding Outlie
Page 77 and 78:
Infant Hosp Visits (Excluding Outli
Page 79 and 80:
Appendix E: Sensitivity Analysis Re
Page 81 and 82:
Appendix F: Calculation of Savings
Page 83 and 84:
n IHE PublicationsFor additional co
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