Assistive Reproductive Technologies: A Literature Review and ...

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of infant). As a result, these studies underestimate the costs of DET and theeffectiveness of SET at producing a healthy baby given that twins are at greaterrisk for short and long term health complications.Five studies evaluated the impact of IVF reimbursement and policies of SETon health care resources. Overall, an association was observed between IVFreimbursement and a decrease in multiple birth rates. IVF reimbursementwas also associated with increased utilization of IVF services and the numberof SET cycles.n ConclusionIn conclusion, the evidence suggests that reducing the number of embryostransferred per IVF cycle is associated with decreasing health services costs. SETis potentially cost effective compared to DET, particularly when incorporatinglong term health outcomes and defining effectiveness as generating a healthy livebirth. Reimbursing SET IVF is associated with decreasing multiple birth ratesbut also increased utilization of IVF services. Note that there were no studies thatevaluated the costs and effectiveness of PGD.14 Assistive Reproductive Technologies:a Literature Review and Database Analysis
Section 2: Preliminary Analyses of AvailableAlberta Health and Wellness DataWhile there is evidence that ARTs are associated with increased health servicescosts and that policies aimed at reducing the number of embryos transferred perIVF cycle could potentially reduce costs, estimating the magnitude of potentialcost savings first requires an assessment of the cost burden associated withmultiple pregnancies/births in the Alberta context. The objective of this sectionis to explore the impact of multiple births and LBW infants on health resourceutilization and costs in Alberta.n PopulationThe population cohort was comprised of mothers and infants born between April1, 2004 and March 31, 2005. Mothers and infants were identified by reviewingthe Hospital Inpatient database for birth events, which include health recordsfor both infants and mothers. Health services cost data for infants represented 1year cost from birth and therefore comprised data collected from April 1, 2004to March 31, 2006. Health services cost data for mothers represented 1 yearcosts from pregnancy until 3 months post partum and therefore comprise datacollected from July 1, 2003 to June 30, 2005. Identified infants were categorizedas LBW and NBW infants. Low birth weight was defined as weighing < 2500grams and normal birth weight weighing > = 2500 grams. Infants were furthercategorized as a singleton, twin, or HOM.n Cost DataCost data was received from AHW on February 22, 2008. Cost data wasextracted from two Alberta provincial health ministry databases. The HospitalInpatient database provided information related to hospital utilization costs.Each hospital admission is assigned a case mix group (CMG) according to theclassification system developed by the Canadian Institute for Health Information(CIHI) 24 and a corresponding resource intensity weight (RIW), which is anindex of resource use that corresponds to the case mix group. The cost perweighted case (provided by CIHI) is multiplied by the RIW providing a cost foreach procedure/intervention. Inpatient cost data were provided separately formothers and infants. Information contained in the inpatient datasets includedan anonymized patient code, length of stay, infant weight group, and the “bestavailable cost” associated with each hospital event for each infant (over 1 yearafter birth) and mother (from pregnancy to 3 months post partum). Best availableAssistive Reproductive Technologies:a Literature Review and Database Analysis 15
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 and 14: Section 1: Review of Economic Studi
Page 15 and 16: naturally in 2003). Cost data was d
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: the analysis had a relatively short
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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