Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Canada.
Hum Reprod. 2014 Jun;29(6):1313-9. doi: 10.1093/humrep/deu067. Epub 2014 Apr 4.
What was the clinical and economic impact of universal coverage of IVF in Quebec, Canada, during the first calendar year of implementation of the public IVF programme?
Universal coverage of IVF increased access to IVF treatment, decreased the multiple pregnancy rate and decreased the cost per live birth, despite increased costs per cycle.
Public funding of IVF assures equality of access to IVF and decreases multiple pregnancies resulting from this treatment. Public IVF programmes usually mandate a predominant SET policy, the most effective approach for reducing the incidence of multiple pregnancies.
STUDY DESIGN, SIZE, DURATION: This prospective comparative cohort study involved 7364 IVF cycles performed in Quebec during 2009 and 2011 and included an economic analysis.
PARTICIPANTS/MATERIALS, SETTING, METHODS: IVF cycles performed in the five centres offering IVF treatment in Quebec during 2009, before implementation of the public IVF programme, were compared with cycles performed at the same centres during 2011, the first full calendar year following implementation of the programme. Data were obtained from the Canadian Assisted Reproductive Technologies Register (CARTR). Comparisons were made between the two periods in terms of utilization, pregnancy rates, multiple pregnancy rates and costs.
The number of IVF cycles performed in Quebec increased by 192% after the new policy was implemented. Elective single-embryo transfer was performed in 1.6% of the cycles during Period I (2009), and increased to 31.6% during Period II (2011) (P < 0.001). Although the clinical pregnancy rate per embryo transfer was lower in 2011 than in 2009 (24.9 versus 39.9%, P < 0.001), the multiple pregnancy rate was greatly reduced (6.4 versus 29.4%, P < 0.001). The public IVF programme increased government costs per IVF treatment cycle from CAD$3730 to CAD$4759. Despite increased costs per cycle, the efficiency defined by the cost per live birth, which factored in downstream health costs up to 1 year post delivery, decreased from CAD$49 517 to CAD$43 362 per baby conceived by either fresh and frozen cycles.
LIMITATIONS, REASONS FOR CAUTION: The costs described in the economic model are likely an underestimate as they do not factor in many of the long-term costs that can occur after 1 year of age. The information collected in the Canadian ART register precludes the calculation of cumulative pregnancy rates.
Our study confirms that the implementation of a public IVF programme favouring eSET not only sharply decreases the incidence of multiple pregnancy, but also reduces the cost per live birth.
STUDY FUNDING/COMPETING INTEREST(S): M.P.V. holds a fellowship award from the Canadian Institutes of Health Research (CIHR). The economic analysis performed by M.P.C. was supported by an unrestricted grant from Ferring Pharmaceutical.
在加拿大魁北克省公共试管婴儿计划实施的第一个日历年内，试管婴儿治疗的普遍覆盖对临床和经济有何影响？
尽管每个周期的成本增加，但试管婴儿治疗的普遍覆盖增加了试管婴儿治疗的可及性，降低了多胎妊娠率，并降低了每活产的成本。
试管婴儿治疗的公共资助确保了试管婴儿治疗的平等可及性，并减少了由此治疗引起的多胎妊娠。公共试管婴儿计划通常要求采用主要的 SET 政策，这是降低多胎妊娠发生率的最有效方法。
研究设计、规模和持续时间：这项前瞻性比较队列研究涉及了 2009 年和 2011 年在魁北克进行的 7364 个试管婴儿周期，并进行了经济分析。
参与者/材料、设置、方法：在 2009 年实施公共试管婴儿计划之前，在魁北克提供试管婴儿治疗的五个中心进行的试管婴儿周期与 2011 年在同一中心进行的周期进行了比较，这是该计划实施后的第一个完整日历年。数据来自加拿大辅助生殖技术登记处（CARTR）。在两个时期内，比较了利用率、妊娠率、多胎妊娠率和成本。
新政策实施后，魁北克的试管婴儿周期数量增加了 192%。在第一期（2009 年），选择性单胚胎移植在 1.6%的周期中进行，而在第二期（2011 年）增加到 31.6%（P<0.001）。尽管 2011 年的胚胎移植临床妊娠率低于 2009 年（分别为 24.9%和 39.9%，P<0.001），但多胎妊娠率大大降低（分别为 6.4%和 29.4%，P<0.001）。公共试管婴儿计划使政府每个试管婴儿治疗周期的成本从 3730 加元增加到 4759 加元。尽管每个周期的成本增加，但以活产为成本效率的定义降低了，这考虑了交付后 1 年内的下游健康成本，从每个活产婴儿的 49517 加元降至 43362 加元。
局限性、谨慎的原因：经济模型中描述的成本可能被低估，因为它们没有考虑到许多可能在 1 岁后出现的长期成本。加拿大 ART 登记处收集的信息无法计算累积妊娠率。
我们的研究证实，实施有利于 eSET 的公共试管婴儿计划不仅大大降低了多胎妊娠的发生率，而且还降低了每活产的成本。
研究资金/利益冲突：M.P.V. 持有加拿大卫生研究院（CIHR）的奖学金。M.P.C. 进行的经济分析得到了 Ferring 制药公司的一项不受限制的赠款的支持。
