Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology

Abstract

Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings.

Economic value of in vitro fertilization in Ukraine, Belarus, and Kazakhstan

“…The following assumptions were used in this scenario: The birth rate from the IVF procedure was calculated from data on IVF success rate and multiple pregnancies from the study conducted by Kupka et al18Because of the low incidence of triple births (1% for both Ukraine and Kazakhstan)18 this parameter was accounted together with dual birthsBecause no Belarus-specific data were available, the rate of births due to IVF was calculated as an average in Russia, Belarus, and Kazakhstan18Negative health impact and higher costs associated with multiple pregnancies included the following: higher probability of dying during neonatal the period (6.4 times);19 higher medical costs during the 1st year of life (the calculated cost ratio between single and dual births, 3.29);19 and doubled payments for “maternity support” because of multiple births.…”

Single vs Multiple Embryo Transfer

“…The authors were able to take advantage of a validated linkage system between a regional birth registry, a reproductive technology registry, death certificates, and an inpatient hospital admission database to perform one of the largest population assessments of costs attributable to SET vs MET to date. 8 The study's authors demonstrated that, compared with singletons, twins and higher-order multiple children were 3.4 and 9.6 times more likely to be stillborn, respectively, and 6.4 and 36.7 times more likely to die during the neonatal period, respectively. Twins and higher-order multiples were 18.7 and 525.1 more times likely to be preterm and small for gestational age, respectively.…”

“…A 2002 study told us that, in the United States, insurance coverage of IVF is a key factor in how parents, like those in the Chambers et al study, 8 make their decisions around embryo transfer. Statemandated insurance coverage of IVF services in 5 states was shown to increase overall IVF use but decrease the number of embryos transferred per cycle and the percentage of pregnancies with 3 or more fetuses.…”

Comparação entre uma transferência eletiva de dois embriões e duas transferências eletivas sequenciais de um embrião: impacto nas taxas de sucesso e de gestação múltipla

“…A ocorrência de gestações múltiplas se destaca, principalmente por estar diretamente relacionada ao número de embriões transferidos (Kallen et al, 2005a). As adversidades decorrentes de gestações múltiplas são bem conhecidas e compreendem riscos maternos e para o neonato (Zollner and Dietl, 2013;Chambers et al, 2014;Murray and Norman, 2014), bem como aumento significativo de custos por hospitalização nos primeiros cinco anos de vida (van Heesch et al, 2015). Diante disso, considerando as questões financeiras e expectativas dos casais em tratamento de infertilidade, esse trabalho visou demonstrar os benefícios da SET aplicada corretamente para a parcela de casais de bom prognóstico.…”

“…Após um acordo entre as clínicas de FIV suecas, no início da década de 90, para a redução da transferência de 3 para 2 embriões, essas taxas caíram para 18,5% (Kallen et al, 2005b). Uma nova recomendação foi feita posteriormente no início dos anos 2000 indicando a transferência preferencial de embrião único, o que resultou em redução das gestações múltiplas para 5% (Kallen et al, 2010 (Zollner and Dietl, 2013;Chambers et al, 2014;Murray and Norman, 2014). Além das complicações perinatais, os riscos de hospitalização de crianças gemelares são cinco vezes maiores do que de crianças nascidas de gestações únicas, com aumento significante nos custos decorrentes de hospitalizações nos cinco primeiros anos de vida (van Heesch et al, 2015).…”