Economic implications of the Society for Assisted Reproductive Technology embryo transfer guidelines: healthcare dollars saved by reducing iatrogenic triplets

Abstract

Iatrogenic HOM gestations represent a substantial economic burden to our healthcare system. The introduction of guidelines for ET in 1998 coincided with a dramatic decrease in the HOM rate in subsequent years and an associated cumulative cost savings of more than $6B. Further reductions in HOM gestations could save up to an additional $2B annually.

Guidance for elective single-embryo transfer should be applied to frozen embryo transfer cycles

“…Lemos et al [6] estimated that the average total cost for mother and infant after a singleton delivery was $21,458, while twins were estimated at $104,831, and higher-order multiples were estimated at $407,199. Additionally, Lee et al [7] estimated that the cumulative cost savings to the US healthcare system for the decrease in the number of high-order multiple (HOM) births that have occurred since the initial SART guidelines on the number of embryos transferred was published in 1998 is more than US$6 billion. However, they found that the decrease in HOM births during this time period was not accompanied by a decrease in the twin rate.…”

“…However, they found that the decrease in HOM births during this time period was not accompanied by a decrease in the twin rate. They suggest an additional $2B may be saved annually with the continued reduction in iatrogenic twins [7]. Crawford et al [8] also examined the costs of achieving live birth from ART.…”

“…It has also been shown that ART-conceived twins are at greater risk for pregnancy complications and adverse perinatal outcome than non-ART-conceived twins [5]. Furthermore, this led to an escalation in healthcare costs, in large part, due to the lengthy stay in the neonatal intensive care unit required for babies born either preterm or very preterm [6][7][8].…”

Modelo de impacto orçamentário da aplicação do single embryo transfer consecutivo comparado com o double embryo transfer em tratamentos de fertilização in vitro no Sistema de Saúde Suplementar

“…Assim, a técnica de SET sequencial (SET + SET) não só consegue minimizar a probabilidade de gravidez múltipla, quando comparada à técnica de DET, mas também tem o potencial de reduzir o risco de complicações da gestação e minimizar a chance de prematuridade extrema, baixo peso ao nascer e complicações associadas, preservando as taxas de gravidez (Cutting, 2018;Grady et al, 2012;Meldrum et al, 2018). Diversos estudos econômicos foram produzidos para estimar a custo-efetividade das técnicas de SET e DET, e o impacto econômico das gestações múltiplas no sistema de saúde (Carpinello et al, 2016;Hernandez Torres et al, 2015;Lee et al, 2016). No entanto, não há uma concordância universal sobre o tema, isso porque as análises produzidas são fortemente influenciadas pelos procedimentos médicos praticados em cada localização geográfica, tal como custo da intervenção médica e medicação necessária.…”

Length of stay and cost of birth hospitalization: effects of subfertility and ART

“…Treatment with assisted reproductive technology (ART) is one example where both the patient and the payor can incur a large cost from both the procedure itself (3) and downstream associated costs related to excess morbidity and mortality of the offspring (e.g. extreme preterm birth) and the mother (3, 4). There are particular challenges in understanding the economics of infertility care and ART that are driven by the outcome being studied (e.g.…”