Fiddelers A A A, Severens J L, Dirksen C D, Dumoulin J C M, Land J A, Evers J L H
Department of Clinical Epidemiology and Medical Technology Assessment, Research Institute Grow & Development and Care and Public Health Research Institute, Academic Hospital Maastricht, Maastricht, The Netherlands.
Hum Reprod Update. 2007 Jan-Feb;13(1):5-13. doi: 10.1093/humupd/dml053. Epub 2006 Nov 10.
Multiple pregnancies lead to complications and induce high costs. The most successful way to decrease multiple pregnancies in IVF is to transfer only one embryo, which might reduce the efficacy of treatment. The objective of this review is to determine which embryo-transfer policy is most cost-effective: elective single-embryo transfer (eSET) or double-embryo transfer (DET). Several databases were searched for (cost* or econ*) and (single embryo* or double embryo* or one embryo* or two embryo* or elect* embryo or multip* embryo*). On the basis of five exclusion criteria, titles and abstracts were screened by two individual reviewers. The remaining papers were read for further selection, and data were extracted from the selected studies. A total of 496 titles were identified through the searches and resulted in the selection of one observational study and three randomized studies. Study characteristics, total costs and probability of live births were extracted. Besides this, cost-effectiveness and incremental cost-effectiveness were derived. It can be concluded that DET is the most expensive strategy. DET is also most effective if performed in one fresh cycle. eSET is only preferred from a cost-effectiveness point of view when performed in good prognosis patients and when frozen/thawed cycles are included. If frozen/thawed cycles are excluded, the choice between eSET and DET depends on how much society is willing to pay for one extra successful pregnancy.
多胎妊娠会引发并发症并导致高昂费用。体外受精（IVF）中减少多胎妊娠最成功的方法是仅移植一个胚胎，这可能会降低治疗效果。本综述的目的是确定哪种胚胎移植策略最具成本效益：选择性单胚胎移植（eSET）还是双胚胎移植（DET）。检索了几个数据库，搜索词为（cost* 或 econ*）以及（single embryo* 或 double embryo* 或 one embryo* 或 two embryo* 或 elect* embryo 或 multip* embryo*）。基于五条排除标准，由两位独立评审员筛选标题和摘要。对剩余论文进行进一步阅读以作选择，并从选定研究中提取数据。通过检索共识别出496个标题，最终选定一项观察性研究和三项随机研究。提取了研究特征、总成本和活产概率。除此之外，还得出了成本效益和增量成本效益。可以得出结论，双胚胎移植是最昂贵的策略。如果在一个新鲜周期内进行，双胚胎移植也是最有效的。仅在预后良好的患者中进行且纳入冷冻/解冻周期时，从成本效益角度来看选择性单胚胎移植才更受青睐。如果排除冷冻/解冻周期，选择性单胚胎移植和双胚胎移植之间的选择取决于社会愿意为多一次成功妊娠支付多少费用。
