%0 Journal Article %1 Little2006 %A Little, Sarah E %A Ratcliffe, Jennifer %A Caughey, Aaron B %D 2006 %J Obstet Gynecol %K Adult; Analysis of Variance; Cerebral Palsy; Cost-Benefit Analysis; Decision Support Techniques; Embryo Transfer; Female; Fertilization in Vitro; Health Care Costs; Humans; Markov Chains; Maternal Age; Monte Carlo Method; Multiple Birth Offspring; Pregnancy; Pregnancy Outcome; Rate; Pregnancy, Multiple; Premature Birth; United States %N 3 Pt 1 %P 593--601 %R 10.1097/01.AOG.0000230534.54078.b3 %T Cost of transferring one through five embryos per in vitro fertilization cycle from various payor perspectives. %U http://dx.doi.org/10.1097/01.AOG.0000230534.54078.b3 %V 108 %X OBJECTIVE: We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer. METHODS: Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models stratified by maternal age subgroup. We modeled both total costs, cost-effectiveness (cost per live birth), and clinical outcomes: multiple births, preterm deliveries, and cerebral palsy. RESULTS: From a societal and insurer perspective, it was least expensive to transfer one embryo. For women aged younger than 35 years, it cost society 80\% more to transfer five rather than one embryo at a time (total cost 39,212 dollars compared with 21,661 dollars). For women aged older than 42 years, it cost 13\% more (29,102 dollars compared with 25,723 dollars). From a parental perspective, it was least expensive to transfer between two and five embryos, depending on maternal age. One-embryo transfers markedly improved clinical outcomes. For example, two compared with one-embryo transfers for women aged younger than 35 years reduced preterm birth and cerebral palsy rates by 55\% and 41\%, respectively. Univariable sensitivity analysis and Monte Carlo simulation showed our results to be robust. CONCLUSION: Transferring one embryo per cycle is the least expensive strategy from a societal perspective, especially for younger women, yet it is the most expensive option from a parental perspective. To reduce in vitro fertilization-associated multiple birth rates, public policy must address these disparate financial incentives.

@article{Little2006, abstract = {OBJECTIVE: We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer. METHODS: Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models stratified by maternal age subgroup. We modeled both total costs, cost-effectiveness (cost per live birth), and clinical outcomes: multiple births, preterm deliveries, and cerebral palsy. RESULTS: From a societal and insurer perspective, it was least expensive to transfer one embryo. For women aged younger than 35 years, it cost society 80\% more to transfer five rather than one embryo at a time (total cost 39,212 dollars compared with 21,661 dollars). For women aged older than 42 years, it cost 13\% more (29,102 dollars compared with 25,723 dollars). From a parental perspective, it was least expensive to transfer between two and five embryos, depending on maternal age. One-embryo transfers markedly improved clinical outcomes. For example, two compared with one-embryo transfers for women aged younger than 35 years reduced preterm birth and cerebral palsy rates by 55\% and 41\%, respectively. Univariable sensitivity analysis and Monte Carlo simulation showed our results to be robust. CONCLUSION: Transferring one embryo per cycle is the least expensive strategy from a societal perspective, especially for younger women, yet it is the most expensive option from a parental perspective. To reduce in vitro fertilization-associated multiple birth rates, public policy must address these disparate financial incentives.}, added-at = {2014-07-19T20:42:51.000+0200}, author = {Little, Sarah E and Ratcliffe, Jennifer and Caughey, Aaron B}, biburl = {https://www.bibsonomy.org/bibtex/207f77e73f431418564ed9d38700c8b3f/ar0berts}, doi = {10.1097/01.AOG.0000230534.54078.b3}, groups = {public}, interhash = {2fa1268d3475cae3e5fc657cc53d1717}, intrahash = {07f77e73f431418564ed9d38700c8b3f}, journal = {Obstet Gynecol}, keywords = {Adult; Analysis of Variance; Cerebral Palsy; Cost-Benefit Analysis; Decision Support Techniques; Embryo Transfer; Female; Fertilization in Vitro; Health Care Costs; Humans; Markov Chains; Maternal Age; Monte Carlo Method; Multiple Birth Offspring; Pregnancy; Pregnancy Outcome; Rate; Pregnancy, Multiple; Premature Birth; United States}, month = Sep, number = {3 Pt 1}, pages = {593--601}, pii = {108/3/593}, pmid = {16946220}, timestamp = {2014-07-19T20:42:51.000+0200}, title = {Cost of transferring one through five embryos per in vitro fertilization cycle from various payor perspectives.}, url = {http://dx.doi.org/10.1097/01.AOG.0000230534.54078.b3}, username = {ar0berts}, volume = 108, year = 2006 }