Chambers Georgina M, Ledger William
National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
School of Women's and Children's Health, University of New South Wales, Level 1, Royal Hospital for Women, Sydney, Australia.
Semin Fetal Neonatal Med. 2014 Aug;19(4):254-61. doi: 10.1016/j.siny.2014.04.004. Epub 2014 Jun 3.
The clinical risks to mothers and babies associated with assisted reproductive technology (ART) multiple birth pregnancies are well described and widely recognized. In contrast, the long-term economic consequences that follow are less appreciated. The few economic analyses that do exist consistently demonstrate the greater patient, healthcare and societal costs associated with twins and higher-order multiples when compared with singleton infants, and convincingly add to the argument that single embryo transfer should be standard practice in most patient groups. Several recent studies have shown that the relative price paid by patients for ART treatment not only has implications for who can afford to access treatment, but also plays an important role in incentivizing embryo transfer practices and thus ART multiple birth rates. This review summarizes the current literature on the costs and consequences of ART multiple births, the contribution of ART multiple births to the economic burden associated with preterm birth, the evidence for the cost-effectiveness of single embryo transfer, and the association between the cost of treatment and the downstream costs associated with multiple births.
与辅助生殖技术（ART）多胎妊娠相关的母婴临床风险已有详尽描述且广为人知。相比之下，后续的长期经济后果则较少受到重视。现有的少数经济分析一致表明，与单胎婴儿相比，双胞胎及更高阶多胞胎会给患者、医疗保健及社会带来更高的成本，这有力地支持了在大多数患者群体中应将单胚胎移植作为标准做法的观点。最近的几项研究表明，患者为ART治疗支付的相对价格不仅影响谁有能力获得治疗，而且在激励胚胎移植做法以及ART多胎出生率方面也起着重要作用。本综述总结了关于ART多胎妊娠的成本和后果、ART多胎妊娠对早产相关经济负担的影响、单胚胎移植成本效益的证据，以及治疗成本与多胎妊娠相关下游成本之间的关联的当前文献。
