Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis

Kjellberg, Ann Thurin; Carlsson, Per; Bergh, Christina

doi:10.1093/humrep/dei298

Cited by 167 publications

(103 citation statements)

References 26 publications

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“…To ensure the applicability of this relative reduction to our modelled cohorts, we applied the same selection criteria for eSET as was used in the randomised controlled trials from which the multiplier was derived. 46 This approach yielded live birth rates following eSET that were congruent with those observed in other randomised trials. 6 A further weakness was that we were unable to assess relative cost-effectiveness of transferring blastocyst-stage embryos as opposed to cleavage-stage embryos.…”

Section: Strengths and Weaknessessupporting

confidence: 73%

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

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objectives 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.Please cite this paper as: Scotland G, McLernon D, Kurinczuk J, McNamee P, Harrild K, Lyall H, Rajkhowa M, Hamilton M, Bhattacharya S. 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.

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Section: Strengths and Weaknessessupporting

confidence: 73%

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

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…With respect to artificial reproductive techniques, the trend towards single embryo transfer might well lead to reduction of severe maternal morbidity because women with multiple pregnancies were at higher risk. 28 We found BMI to be an important risk factor for severe maternal morbidity. As the incidence of overweight and obesity is increasing rapidly in Western countries, we expect severe maternal morbidity to increase in the future.…”

Section: Discussionmentioning

confidence: 72%

Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies

Zwart

Richters

Öry³

et al. 2008

BJOG

319

163

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Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.Design Prospective population-based cohort study.Setting All 98 maternity units in the Netherlands.Population All pregnant women in the Netherlands.Methods Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit.Main outcome measures Incidence, case fatality rates, possible risk factors and substandard care.Results Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit.Conclusions Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.Keywords Ethnicity, incidence, maternal mortality, nationwide, risk factors, severe maternal morbidity, substandard care.Please cite this paper as: Zwart J, Richters J, Ö ry F, de Vries J, Bloemenkamp K, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371 000 pregnancies. BJOG 2008;115:842-850.

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“…early work by gerris et al (2004) showed, in a non-randomised study, that the transfer of a top-quality embryo was associated with significantly lower costs in women under 38 years during their first cycle. this observation was confirmed by Kjellberg et al (2006) with respect to the costs associated with complications of multiple pregnancy. many studies support the cost-effectiveness of eSet especially when cumulative rates with frozen embryo replacement cycles are taken into consideration with Scotland et al, (2011) providing a uK perspective.…”

Section: Cost Implications and Commissioning Considerationsmentioning

confidence: 55%

Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

et al. 2015

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Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis

Cited by 167 publications

References 26 publications

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

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

Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies

Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

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