按移植胚胎数量分层的体外受精后围产期后续结局的成本影响：佛蒙特州数据的五年分析

Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data.

作者信息

Carpinello Olivia J, Casson Peter R, Kuo Chia-Ling, Raj Renju S, Sills E Scott, Jones Christopher A

机构信息

University of Vermont College of Medicine, Burlington, VT, USA.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.

出版信息

Appl Health Econ Health Policy. 2016 Jun;14(3):387-95. doi: 10.1007/s40258-016-0237-2.

DOI:10.1007/s40258-016-0237-2

PMID:26969653

Abstract

BACKGROUND

In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes.

OBJECTIVE

To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth.

METHODS

Medical records of patients who conceived with IVF (n = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated.

RESULTS

The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively.

CONCLUSION

Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.

摘要

背景

在美国一些没有体外受精（IVF）保险覆盖的州，每个周期移植的胚胎更多，导致多胎妊娠和不良妊娠结局的风险更高。

目的

根据IVF期间移植的胚胎数量，确定选定的围产期不良并发症的发生率和成本，并计算每例IVF活产的增量成本。

方法

评估2007年至2011年期间通过IVF受孕并在孕龄>20周时分娩的患者（n = 116）的病历。列出分娩时的孕龄、低体重（LBW）足月分娩和分娩方式。计算每个队列的医疗保健成本、假设每个队列有100名患者的推算成本以及每个分娩婴儿的增量成本。

结果

双胚胎移植（DET）后早产和剖宫产率最高，而单胚胎移植（SET）中最低。单胎早产率随移植胚胎数量直接增加[6.3%（SET），9.1%（DET），≥3个胚胎移植时为10.0%]。剖宫产率也有此趋势[26.7%（SET），36.6%（DET），≥3个胚胎移植时为47.1%]。DET后分娩及≥3个胚胎移植后的分娩中，LBW婴儿的比例分别为3.9%和9.1%。SET、DET和≥3个胚胎移植的每个队列推算成本分别为718,616美元、1,713,470美元和1,227,396美元。