Brännström Mats, Ekberg Jana, Sandman Lars, Davidson Thomas
Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Stockholm IVF-EUGIN, Stockholm, Sweden.
Hum Reprod. 2025 Feb 1;40(2):310-318. doi: 10.1093/humrep/deae272.
What is the cost per live birth after live donor uterus transplantation in a Swedish clinical trial setting?
The total cost per child, from a health care perspective, was calculated to be €124 894 and if only surgically successful transplants are considered, the total cost per live birth was €107 120.
Uterus transplantation has proved to be a feasible treatment for uterine factor infertility by accomplished live births, both after live donor and deceased donor transplantation procedures. Our previous study, the only existing cost analysis of uterus transplantation, found that the initial (up to 2 months after surgeries) societal costs of preoperative interventions, live donor uterus transplantation surgeries, and postoperative care were between €50 000 and €100 000 (mean €74 000) in Year 2020 values per uterus transplantation. That study also included costs of sick leave for both donors and recipients.
STUDY DESIGN, SIZE, DURATION: This real-data health economic cost study is based on a prospective cohort study, which included nine live donor uterus transplantation procedures. Study duration included the time from the first pre-transplantation investigation until postoperative controls after graft removal.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Recipients, live donors, and neonates of nine uterus transplantation procedures participated. The recipients and donors underwent pre-transplantation investigations with imaging, laboratory tests, and psychological/medical screening. In vitro fertilization with embryo cryopreservation was performed in advance of transplantation. Donor hysterectomy and transplantation were by laparotomy and the recipient received immunosuppression. Pregnancy attempts by ET started 1 year after transplantation and delivery was by caesarean section. Hysterectomy was performed either after birth of one or two children, after graft failure, or after multiple pregnancy failures. Nine transplantation procedures resulted in seven surgically successful (adequate blood flow and regular menstruations) grafts and six women delivered a total of nine children.
The total cost of preoperative investigations, live donor uterus transplantation, postoperative care, immunosuppression, IVF, follow-up, pregnancy care, delivery, and graft removal after completed childbirth(s) or failure to achieve live birth was calculated, based on inclusion of cost for six women, giving birth to a total of nine children, and three women, with no childbirth. Cost for live donors was also included in the analysis. The total cost per child was calculated to be €124 894. However, if only surgical successful transplants (seven out of nine transplants) are considered, the cost per live birth was €107 120. The cost for preoperative preparations with IVF, surgeries, and postoperative follow-up during the initial 2 months was around 53% of total costs. Smaller sub-costs were those for monitoring, ETs with additional IVF (14%), immunosuppression and other drugs from Month 3 until hysterectomy (13%), and pregnancy care with delivery and neonatal care (13%).
LIMITATIONS, REASONS FOR CAUTION: Limitations are the restricted sample size, the experimental phase of the procedure and that the results only reflect the cost in one country (Sweden).
The results provide the first information concerning the cost per child of the uterus transplantation intervention. In the future, the cost per child will most likely decrease due to predicted increase in the rate of surgical success, decreased surgical durations, decreased graft duration to achieve live birth(s), and increased rate of transplantations giving not only one, but two or three singletons.
STUDY FUNDING/COMPETING INTEREST(S): Funding was received from the Jane and Dan Olsson Foundation for Science, the Knut and Alice Wallenberg Foundation, the Swedish Research Council, and an ALF grant from the Swedish state under an agreement between the government and the county councils. There are no conflicts of interest for any of the authors.
NCT01844362.
在瑞典的临床试验环境中，活体供体子宫移植后每例活产的成本是多少？
从医疗保健角度计算，每个孩子的总成本为124,894欧元；如果仅考虑手术成功的移植，每例活产的总成本为107,120欧元。
子宫移植已被证明是一种治疗子宫因素不孕症的可行方法，通过活体供体和已故供体移植程序均已实现活产。我们之前的研究是子宫移植唯一现有的成本分析，发现2020年每例子宫移植术前干预、活体供体子宫移植手术和术后护理的初始（手术后头2个月）社会成本在50,000欧元至100,000欧元之间（平均74,000欧元）。该研究还包括供体和受体的病假成本。
研究设计、规模、持续时间：这项基于真实数据的卫生经济成本研究基于一项前瞻性队列研究，该研究包括9例活体供体子宫移植手术。研究持续时间包括从首次移植前调查到移植后移植物切除后的术后对照的时间。
参与者/材料、环境、方法：9例子宫移植手术的受体、活体供体和新生儿参与了研究。受体和供体接受了影像学、实验室检查以及心理/医学筛查等移植前调查。在移植前进行了胚胎冷冻保存的体外受精。供体子宫切除术和移植通过剖腹手术进行，受体接受免疫抑制治疗。移植后1年开始通过胚胎移植尝试怀孕，分娩通过剖宫产进行。在生育一两个孩子后、移植物失败后或多次怀孕失败后进行子宫切除术。9例移植手术中有7例手术成功（血流充足且月经规律）的移植物，6名女性共分娩了9个孩子。
计算了术前检查、活体供体子宫移植、术后护理、免疫抑制、体外受精、随访、孕期护理、分娩以及分娩完成或未实现活产后移植物切除的总成本，纳入了6名生育了9个孩子的女性和3名未生育女性的成本，分析中还包括了活体供体的成本。计算得出每个孩子的总成本为124,894欧元。然而，如果仅考虑手术成功的移植（9例移植中的7例），每例活产的成本为107,120欧元。最初2个月内体外受精、手术及术后随访的术前准备成本约占总成本的53%。较小的子成本包括监测、额外体外受精的胚胎移植（14%）、第3个月至子宫切除期间的免疫抑制及其他药物（13%）以及孕期护理、分娩和新生儿护理（13%）。
局限性、需谨慎的原因：局限性在于样本量有限、该程序尚处于实验阶段且结果仅反映一个国家（瑞典）的成本。
该结果提供了关于子宫移植干预每个孩子成本的首个信息。未来，由于预计手术成功率提高、手术时间缩短、实现活产的移植物持续时间缩短以及不仅能生育一个，还能生育两个或三个单胎的移植率增加，每个孩子的成本很可能会降低。
研究资金/利益冲突：获得了简和丹·奥尔松科学基金会、克努特和爱丽丝·瓦伦贝里基金会、瑞典研究理事会的资助，以及瑞典政府与郡议会协议下瑞典国家提供的一项ALF资助。所有作者均无利益冲突。
NCT01844362
