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Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and
G M Chambers1, E Lee, V P Hoang
1National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales (UNSW), Level 2, McNevin Dickson Building, Randwick Hospitals Campus, Sydney 2031, Australia.
Insights
Children conceived via assisted reproduction technologies (ART) have longer birth hospital stays and increased readmission risks, leading to higher healthcare costs in their first five years compared to naturally conceived children.
Area of Science:
- Reproductive Medicine and Healthcare Economics
- Perinatal Health Outcomes
- Public Health Policy
Background:
- Assisted reproduction technologies (ART) singletons face higher risks of adverse perinatal outcomes.
- Existing research offers limited data on the health service utilization and economic impact of ART-conceived children.
- Understanding these impacts is crucial for healthcare resource allocation and ART research.
Purpose of the Study:
- To determine if singletons conceived via ART exhibit significantly different hospital utilization and associated costs compared to non-ART children within the first five years of life.
Main Methods:
- A population-based cohort study utilized linked birth, hospital admission, and death records in Western Australia (1994-2003 births, linked to 2008).
- Compared perinatal outcomes, hospital utilization, costs, and mortality rates for 2199 ART singletons and 224,425 non-ART singletons up to age 5.
- Adjusted for maternal age, parity, sex, birth year, socioeconomic status, and funding source; costs derived using Australian Diagnosis Related Groups (DRG) cost-weights (2009/2010 AUD).
Main Results:
- ART singletons experienced significantly longer birth admissions (mean difference 1.8 days) and a 20% higher risk of readmission within five years.
- Average adjusted additional hospital admission costs up to age 5 were $2490, with $1473 attributed to the birth admission.
- ART conception predicted higher birth admission costs ($342) and excess costs ($548) up to age 5.
Conclusions:
- ART singletons incur higher hospital admission costs during birth and up to five years of age compared to non-ART singletons.
- While ART singletons show increased healthcare utilization, the impact is substantially less than that observed for ART multiple births.
- Awareness of these increased hospitalization risks and costs is vital for clinicians, patients, and healthcare policy.
Study Question:
Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life?
Summary Answer:
ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care.
What Is Known Already:
ART singletons are at greater risk of adverse perinatal outcomes compared with non-ART singletons. Long-term physical and mental health outcomes of ART singletons are generally reassuring. There is a scarcity of information on health service utilization and the health economic impact of ART conceived children.
Study Design, Size, Duration:
A population cohort study using linked birth, hospital and death records. Perinatal outcomes, hospital utilization and costs, and mortality rates were compared for non-ART and ART singletons to 5 years. Adjustments were made for maternal age, parity, sex, birth year, socioeconomic status and funding source. Australian Diagnosis Related Groups cost-weights were used to derive costs. All costs are reported in 2009/2010 Australian dollars.
Participants/Materials, Setting, Methods:
All babies born in Western Australia between 1994 and 2003 were included; 224 425 non-ART singletons and 2199 ART conceived singletons. Hospital admission and death records in Western Australia linked to 2008 were used.
Main Results And The Role Of Chance:
Overall, ART singletons had a significantly longer length of stay during the birth-admission (mean difference 1.8 days, P < 0.001) and a 20% increased risk of being admitted during the first 5 years of life. The average adjusted difference in hospital admission costs up to 5 years of age was $2490, with most of the additional cost occurring during the birth-admission ($1473). The independent residual cost associated with ART conception was $342 during the birth-admission and an additional $548 up to 5 years of age, indicating that being conceived as an ART child predicts not only higher birth-admission costs but excess costs to at least 5 years of age.
Limitations, Reasons For Caution:
This study could not investigate the impact of different ART practices and techniques on perinatal outcomes or hospital utilization, nor could it adjust for parental characteristics such as cause of infertility and treatment-seeking behaviour. This study related to ART treatment undertaken before 2003.
Wider Implications Of The Findings:
Clinicians and patients should be aware of the risk of poorer perinatal outcomes and increased hospitalization of ART singletons compared with non-ART singletons. These differences are significant enough to affect health-care resource consumption, but are substantially and significantly less than those associated with ART multiple birth infants. Understanding the short- and long-term health services and economic impact of ART is important for setting the research agenda in ART, for informing economic evaluations of infertility and treatment strategies, and for providing an important input to clinical and administrative decision making.
Study Funding/Competing Interest(S):
No specific funding was used to undertake this study and the authors report no conflicts of interest. A number of the authors receive Research Grants to their institutions from the Australian Government. G.M.C. receives grant support to her institution from the Australian Government, Australian Research Council (ARC) Linkage Grant No LP1002165; ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. V.P.H. is employed as an Economics Research Associate on the same grant.
Trial Registrations Number:
NA.
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