Direct health services costs of providing assisted reproduction services in older women

Maheshwari, Abha; Scotland, Graham; Bell, Jacqueline; McTavish, Alison; Hamilton, Mark; Bhattacharya, Siladitya

doi:10.1016/j.fertnstert.2009.01.115

Cited by 14 publications

(19 citation statements)

References 30 publications

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“…Increasing embryo aneuploidy with advancing maternal age [29], and increasing miscarriage risk [30], together with higher medication costs, lead to higher treatment costs per cycle, while efficacy of treatments declines in parallel [30]. Cost effectiveness of IVF, therefore, decreases with advancing female age (see also later).…”

Section: Resultsmentioning

confidence: 99%

The “graying” of infertility services: an impending revolution nobody is ready for

Gleicher

Kushnir

Weghofer

et al. 2014

Reprod Biol Endocrinol

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BackgroundAs demand for infertility services by older women continues to grow, because achievable in vitro fertilization (IVF) outcomes are widely underestimated, most fertility centers do not offer maximal treatment options with use of autologous oocytes. Limited data suggest that clinical IVF outcomes in excess of what the American Society for Reproductive Medicine (ASRM) considers “futile” can, likely, be achieved up to at least age 45 years.MethodsIn an attempt to point out an evolving demographic trend in IVF, we here report our center’s IVF data for 2010-2012 and national U.S. data for 1997-2010. Though our center’s data are representative of only one IVF center’s patients, they, likely, are unique since they probably represent the most adversely selected IVF patient population ever reported and, thus, are predictive of future demographic trends. In addition we performed a systematic review of the literature on the subject based on PubMed, Medline and Google Scholar searches till year-end 2013. The literature search was performed using key words and phrases relevant to fertility treatments in older women.ResultsAs demonstrated by our center’s patient demographics and national U.S. data, IVF centers are destined to treat increasingly adversely selected patients. Despite our center’s already extremely adversely selected patient population, age-specific IVF cycle outcomes in women above age 40 years, nevertheless, exceeded criteria for “futility” by the ASRM and widely quoted outcome expectations in the literature for patient ages. Age 43 discriminates between better and poorer clinical pregnancy and live birth rates.Conclusions“Graying” of the infertility populations in the developed world, a problem with potentially far-reaching medical and societal consequences, has so far been only insufficiently addressed in the literature. As women’s postmenopausal life spans already exceed postmenarcheal life spans at the start of the 20th century, the “graying” of infertility services can be expected to further accelerate, no longer as in recent decades bringing only women in their 40s into maternity wards but also women in their 50s and 60s. Medicine and society better get ready for this revolution.

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Section: Resultsmentioning

confidence: 99%

The “graying” of infertility services: an impending revolution nobody is ready for

Gleicher

Kushnir

Weghofer

et al. 2014

Reprod Biol Endocrinol

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“…These guidelines provide suggestions for the usage of SET versus DET dependent on patient age. While SET is favored in most cases, DET may be more efficient and less costly for patients of increased age [30,31]. Studies have also revealed that aside from SET attaining comparable pregnancy and live birth rates to DET as well as decreased risk of multiple pregnancy, SET is more cost efficient than DET in the longterm [21,24,32,33].…”

Section: Set Versus Det and Met Multiple Pregnancy And Metmentioning

confidence: 99%

“…ART treatments, at the very least, incur costs for antenatal care, laboratory resources, hormones, medications, physician labor, and embryo transfer, amongst others [30]. However, the typical estimated financial burden of pregnancy does not include potential expenses relating to complications incurred during pregnancy and/or birth, or even the birth of twins, all of which are more frequent with the use of DET instead of SET [33].…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

“…As many studies have shown, maternal age is the most important, and best, indicator of pregnancy success; it generally informs both embryo quality and frequency, which decrease with increasing age, while abnormalities rise [18,31,44]. Advanced maternal age (AMA), patients 40 years old or more, require larger doses of follicle-stimulating hormone (FSH) to stimulate the follicle to produce collectible eggs as well as more monitoring and tests throughout the treatment cycle [5,30,45]. While progress has been made in terms of pregnancy success in older women (rising from 20.0% to 50.2% between 1997 and 2006), the proportion of women of increased age able to become pregnant is still significantly below that of younger women [30,46].…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

“…Advanced maternal age (AMA), patients 40 years old or more, require larger doses of follicle-stimulating hormone (FSH) to stimulate the follicle to produce collectible eggs as well as more monitoring and tests throughout the treatment cycle [5,30,45]. While progress has been made in terms of pregnancy success in older women (rising from 20.0% to 50.2% between 1997 and 2006), the proportion of women of increased age able to become pregnant is still significantly below that of younger women [30,46]. Unlike many Westernized countries, the United States (US) is only now implementing more of a nation-wide healthcare plan; it is still the case that several US insurance providers do not cover infertility treatments [11].…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

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Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization

Brown¹

2015

JFIV Reprod Med Genet

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In vitro fertilization (IVF), a form of assisted reproductive technology, has expanded since its introduction in the 1970's to enable patients with prolonged infertility and/or clinical complications to produce biological offspring. This review analyzes the topics of controversy surrounding IVF, weighing evidence concerning contemporary fertility techniques that aim to advance the field of IVF. A comparison of single embryo transfer to double embryo transfer, in the context of economic expenditure and the likelihood of multiple pregnancy, provides support for electing the former. An ethically controversial topic is preimplantation genetic screening, a technology with the potential to reduce the incidence of genetic abnormalities, thereby increasing rates of healthy pregnancies. Lastly, the integration of in vitro maturation (IVM) can allow for a more diverse patient population to benefit from IVF treatment, while simultaneously avoiding several of the associated disadvantages. The future of IVF rests on continued research, and the resulting widespread integration of increasingly effective methods.

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Spoilt for Choice: Implications of Using Alternative Methods of Costing Hospital Episode Statistics

et al. 2011

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In the absence of a 'gold standard' to estimate the economic burden of disease, a decision about the most appropriate costing method is required. Researchers have employed various methods to cost hospital stays, including per diem or diagnosis-related group (DRG)-based costs. Alternative methods differ in data collection and costing methodology. Using data from Scotland as an illustrative example, costing methods are compared, highlighting the wider implications for other countries with a publicly financed healthcare system. Five methods are compared using longitudinal data including baseline survey data (Midspan) linked to acute hospital admissions. Cost variables are derived using two forms of DRG-type costs, costs per diem, costs per episode-using a novel approach that distinguishes between variable and fixed costs and incorporates individual length of stay (LOS), and costs per episode using national average LOS. Cost estimates are generated using generalised linear model regression. Descriptive analysis shows substantial variation between costing methods. Differences found in regression analyses highlight the magnitude of variation in cost estimates for subgroups of the sample population. This paper emphasises that any inference made from econometric modelling of costs, where the marginal effect of explanatory variables is assessed, is substantially influenced by the costing method.

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Direct health services costs of providing assisted reproduction services in older women

Cited by 14 publications

References 30 publications

The “graying” of infertility services: an impending revolution nobody is ready for

The “graying” of infertility services: an impending revolution nobody is ready for

Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization

Spoilt for Choice: Implications of Using Alternative Methods of Costing Hospital Episode Statistics

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