Callahan T L, Hall J E, Ettner S L, Christiansen C L, Greene M F, Crowley W F
National Center for Infertility Research, Massachusetts General Hospital, Boston 02114.
N Engl J Med. 1994 Jul 28;331(4):244-9. doi: 10.1056/NEJM199407283310407.
Although the medical complications associated with multiple-gestation pregnancies have been well documented, little is known about the effects of such pregnancies on the use of health care resources and the associated costs. This is an important issue because of the increasing use of assisted-reproduction techniques, which commonly result in multiple-gestation pregnancies.
We determined hospital charges and the use of assisted-reproduction techniques (such as induction of ovulation, in vitro fertilization, and gamete intrafallopian transfer) for 13,206 pregnant women (11,986 with singleton pregnancies, 1135 with twin pregnancies, and 85 with more than two fetuses) who were admitted for delivery to Brigham and Women's Hospital, Boston, in 1986 through 1991 and their 14,033 neonates (11,671 singletons, 2144 twins, and 218 resulting from higher-order multiple gestations).
After we controlled for variables known to affect hospital charges, the predicted total charges to the family in 1991 for a singleton delivery were $9,845, as compared with $37,947 for twins ($18,974 per baby) and $109,765 for triplets ($36,588 per baby). Assisted-reproduction techniques were used in 2 percent of singleton, 35 percent of twin, and 77 percent of higher-order multiple-gestation pregnancies; such procedures were approximately equally divided between induction of ovulation alone and in vitro fertilization or gamete intrafallopian transfer.
Multiple-gestation pregnancies, a high proportion of which result from the use of assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques had been singleton pregnancies, the predicted savings to the health care delivery system in the study hospital alone would have been over $3 million per year. Although assisted reproduction provides tremendous benefits to families with infertility, the increased medical risks entailed by multiple-gestation pregnancies and the associated costs cannot be ignored. We suggest that more attention be paid to approaches to infertility that reduce the likelihood of multiple gestation.
尽管与多胎妊娠相关的医学并发症已有充分记录，但对于此类妊娠对医疗资源使用及相关费用的影响却知之甚少。鉴于辅助生殖技术的使用日益增多，而该技术通常会导致多胎妊娠，这是一个重要问题。
我们确定了1986年至1991年期间在波士顿布里格姆妇女医院分娩的13206名孕妇（11986名单胎妊娠、1135名双胎妊娠和85名多胎妊娠）及其14033名新生儿（11671名单胎、2144名双胎和218名多胎妊娠儿）的住院费用以及辅助生殖技术（如促排卵、体外受精和输卵管内配子移植）的使用情况。
在我们对已知影响住院费用的变量进行控制后，1991年单胎分娩家庭的预计总费用为9845美元，而双胎分娩为37947美元（每个婴儿18974美元），三胎分娩为109765美元（每个婴儿36588美元）。单胎妊娠中有2%使用了辅助生殖技术，双胎妊娠中有35%，多胎妊娠中有77%；此类程序在单纯促排卵与体外受精或输卵管内配子移植之间大致平分。
多胎妊娠，其中很大一部分是由辅助生殖技术导致的，会大幅增加住院费用。如果辅助生殖技术导致的所有多胎妊娠都是单胎妊娠，仅研究医院的医疗保健系统预计每年就能节省超过300万美元。尽管辅助生殖为不孕家庭带来了巨大益处，但多胎妊娠带来的增加的医疗风险及相关费用不容忽视。我们建议更多关注降低多胎妊娠可能性的不孕治疗方法。
