Assistive Reproductive Technologies: A Literature Review and ...

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Appendix B: Summary of StudiesIncluded in ReviewSummary of Primary Studies of the Cost Impact of ARTsAuthor / Country Study Type Objective /PerspectiveEvaluation TypeTimelineKoivurova et al.2007 6FinlandRetrospectiveMatched-CaseControlledAnalysisTo comparepost-neonatalhospital costsbetween IVF/ICSIbirths [singleton(n=153), twins(n=121), triplets(n=25), andquadruplets(n=4)] ANDmatched controls(n=567). Payer’sPerspectiveCosting(2004 £)Birth to 7 yearsof ageChambers et al.2007 7New ZealandRetrospectiveObservationalStudyTo compareinpatient hospitalcosts betweenARTs and non-ARTs: singletons(n=4050 vs241,967), twins(n=1774 vs.6398) and higherorder multiples(n=62 vs 174) ofboth infants andtheir mothers.Payer’sPerspectiveCosting(1998-1999 €)Birth to 5 yearsof ageLedger et al2006 8The UnitedKingdomDAMTo comparethe cost ofIVF singleton(n=4621), twin(n=1579) andtriplet (n=109)pregnancies.Payer’sPerspective.Costing(2002 £)Pregnancy to 1year post delivery38 Assistive Reproductive Technologies:a Literature Review and Database Analysis
Results Study Conclusions Evidence of Increased HealthCare CostsOverall IVF children had highermean visits (1.76 vs. 1.07) andlonger length of stay (4.31 vs.2.61).IVF children cost 2.6 times morethan general population basedcontrols.The incidence of multiple birthsincreases the utilization of postneonatalhealth care servicesand costs among IVF children incomparison to naturally conceivedchildren.Results suggest,that ARTssingletons are associated withhigher hospital costs than naturalsingletons.Compared to non-ARTs infantsARTs infants 4.4 and 5 timesmore likely to be low birthweight and very low birth weightrespectively translating into 89%higher birth admissions costs(€2,832 vs. €1,502)Compared to non ARTs, maternalcosts for ARTs singletons, twinsand HOM were 11%, 6% & 8%higher than non ARTs respectively.Overall cost of all ART births was57% higher than non-ART births.Approximately €9.2 million couldbe saved in birth admissionsalone if ART multiples had beensingleton births. The authorsconclude that the results highlightthe need for policies supportingsingle embryo transfer.Results suggest that ARTs withincreased health care costs.Total costs per IVF pregnancywere £3313 for singleton, £9122for twin and £32,354 for triplet.Multiple pregnancies after IVFwere linked with 56% of the cost,although they made up less than1/3 of the total annual number ofmaternities.Multiple pregnancies from IVF areassociated with high costs to thehealth system.Savings could be made if the SETpolicy were adopted.Because comparisons with non-IVF patients were not made, thecosts directly attributable to ARTsare unclear. Results do not directlylink ARTs with increased healthcare costs.Assistive Reproductive Technologies:a Literature Review and Database Analysis 39
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 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: Data ExtractionExtracted data from
Page 51 and 52: 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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