各州对 ART 覆盖范围的保险要求不同，导致 ICSI 利用率也存在差异。
Differences in ICSI utilization rates among states with insurance mandates for ART coverage.
机构信息
Clinical Outcomes Research Group, CORG LLC, 178 Meadow Brook Rd, Grantham, NH, 03753, USA.
Department of Statistics, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
出版信息
Reprod Biol Endocrinol. 2021 Nov 30;19(1):174. doi: 10.1186/s12958-021-00856-4.
BACKGROUND
Assisted reproductive technology (ART) insurance mandates promote more selective utilization of ART clinic resources including intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ICSI utilization differs by state insurance mandates for ART coverage and assess if such a difference is associated with male factor, preimplantation genetic testing (PGT), and/or live birth rates.
METHODS
In this retrospective analysis of the Centers for Disease Control (CDC) data from 2018, ART clinics in ART-mandated states (n = 8, AR, CT, HI, IL, MD, MA, NJ, RI) were compared individually to one another and with non-mandated states in aggregate (n = 42) for use of ICSI, male factor, PGT, and live birth rates. ANOVA was used to evaluate differences between ART-mandated states and non-mandated states. Individual ART-mandated states were compared using Welch t-tests. Statistical significance was determined by Bonferroni Correction.
RESULTS
There were significant differences in ICSI rates (%, mean ± SD) between MA (53.3 ± 21.3) and HI (90.7 ± 19.6), p = 0.028; IL (86.5 ± 18.7) and MA, p = 0.002; IL and MD (57.2 ± 30.8), p = 0.039; IL and NJ (62.0 ± 26.8), p = 0.007; between non-mandated states in aggregate (79.9 ± 19.9) and MA, p = 0.006, and NJ (62.0 ± 26.8), p = 0.02. Male factor rates of HI (65.8 ± 16.0) were significantly greater compared to CT (18.8 ± 8.7), IL (26.0 ± 11.9), MA (26.9 ± 6.6), MD (29.3 ± 9.9), NJ (30.6 ± 17.9), and non-mandated states in aggregate (29.7 ± 13.7), all p < 0.0001. No significant differences were reported for use of PGT and/or live birth rates across all age groups regardless of mandate status.
CONCLUSIONS
ICSI use varied significantly among ART-mandated states while demonstrating no differences in live birth rates. These data suggest that the prevalence of male factor and the presence of a state insurance mandate are not the only factors influencing ICSI use. It is suggested that other non-clinical factors may impact the rate of ICSI utilization in a given state.
背景
辅助生殖技术 (ART) 保险要求促进了对 ART 诊所资源的更具选择性的利用，包括胞浆内单精子注射 (ICSI)。我们的目的是检查 ICSI 的使用是否因州 ART 保险覆盖范围的要求而有所不同，并评估这种差异是否与男性因素、胚胎植入前遗传学检测 (PGT) 和/或活产率有关。
方法
在这项对疾病控制与预防中心 (CDC) 2018 年数据的回顾性分析中，比较了 ART 授权州 (n=8，AR、CT、HI、IL、MD、MA、NJ、RI) 的 ART 诊所与非授权州的 ICSI、男性因素、PGT 和活产率的使用情况。使用方差分析 (ANOVA) 评估 ART 授权州和非授权州之间的差异。使用 Welch t 检验比较个别 ART 授权州。通过 Bonferroni 校正确定统计学意义。
结果
马萨诸塞州 (53.3%±21.3) 和夏威夷州 (90.7%±19.6) 的 ICSI 率 (%, 均值±标准差) 之间存在显著差异，p=0.028；伊利诺伊州 (86.5%±18.7) 和马萨诸塞州，p=0.002；伊利诺伊州和马里兰州 (57.2%±30.8)，p=0.039；伊利诺伊州和新泽西州 (62.0%±26.8)，p=0.007；非授权州的总活产率 (79.9%±19.9) 与马萨诸塞州，p=0.006，与新泽西州，p=0.02。男性因素 HI 州的比率 (65.8%±16.0) 与 CT (18.8%±8.7)、IL (26.0%±11.9)、MA (26.9%±6.6)、MD (29.3%±9.9)、NJ (30.6%±17.9) 和非授权州的总活产率 (29.7%±13.7) 相比，差异有统计学意义，均 p<0.0001。无论授权状态如何，在所有年龄组中，PGT 和/或活产率的使用均未报告存在显著差异。
结论
在 ART 授权州之间，ICSI 的使用差异显著，而活产率没有差异。这些数据表明，男性因素的流行率和州保险授权的存在并不是影响 ICSI 使用的唯一因素。建议其他非临床因素可能会影响特定州的 ICSI 利用率。
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