Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

G S Scotland, D McLernon, J J Kurinczuk, P McNamee, K Harrild, H Lyall, M Rajkhowa, M Hamilton, S Bhattacharya

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

PObjectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model. Setting Three assisted reproduction centres in Scotland. Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost ~£28 300 and ~£20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged =36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.
Original languageEnglish
Pages (from-to)1073-1083
Number of pages11
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume118
Issue number9
Early online date8 Apr 2011
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Embryo Transfer
Fertilization in Vitro
Single Embryo Transfer
Costs and Cost Analysis
Live Birth
Twin Pregnancy
Quality-Adjusted Life Years
Pregnancy Rate
Therapeutics
Birth Rate
Scotland
Health Care Costs
Uncertainty
Health Services
Cost-Benefit Analysis
Reproduction
Outcome Assessment (Health Care)

Keywords

  • cost-effectiveness
  • in vitro fertilisation
  • single embryo transfer

Cite this

@article{0c0f28facd664bc7b6542818d91ca037,
title = "Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon",
abstract = "PObjectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model. Setting Three assisted reproduction centres in Scotland. Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost ~£28 300 and ~£20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged =36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.",
keywords = "cost-effectiveness, in vitro fertilisation, single embryo transfer",
author = "Scotland, {G S} and D McLernon and Kurinczuk, {J J} and P McNamee and K Harrild and H Lyall and M Rajkhowa and M Hamilton and S Bhattacharya",
note = "{\circledC} 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology {\circledC} 2011 RCOG.",
year = "2011",
month = "8",
doi = "10.1111/j.1471-0528.2011.02966.x",
language = "English",
volume = "118",
pages = "1073--1083",
journal = "BJOG-An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "John Wiley & Sons, Ltd (10.1111)",
number = "9",

}

TY - JOUR

T1 - Minimising twins in in vitro fertilisation

T2 - a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

AU - Scotland, G S

AU - McLernon, D

AU - Kurinczuk, J J

AU - McNamee, P

AU - Harrild, K

AU - Lyall, H

AU - Rajkhowa, M

AU - Hamilton, M

AU - Bhattacharya, S

N1 - © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

PY - 2011/8

Y1 - 2011/8

N2 - PObjectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model. Setting Three assisted reproduction centres in Scotland. Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost ~£28 300 and ~£20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged =36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.

AB - PObjectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model. Setting Three assisted reproduction centres in Scotland. Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost ~£28 300 and ~£20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged =36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.

KW - cost-effectiveness

KW - in vitro fertilisation

KW - single embryo transfer

U2 - 10.1111/j.1471-0528.2011.02966.x

DO - 10.1111/j.1471-0528.2011.02966.x

M3 - Article

C2 - 21477172

VL - 118

SP - 1073

EP - 1083

JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 9

ER -