Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI
M M J van Heesch1, J L H Evers2, M A H B M van der Hoeven3
1Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands mirjam.van.heesch@mumc.nl.
Insights
In vitro fertilization (IVF) multiples incur significantly higher hospital costs than singletons up to age five, primarily due to birth admission expenses. Excluding this period, costs are comparable, suggesting targeted interventions could reduce overall healthcare spending.
Area of Science:
- Reproductive Medicine
- Health Economics
- Pediatric Healthcare
Background:
- Rising concerns exist regarding the long-term health outcomes of children conceived via in vitro fertilization (IVF).
- Multiple births resulting from double-embryo transfer in IVF are linked to poorer neonatal outcomes, including prematurity and low birthweight, necessitating increased medical care.
- The financial implications of these poorer neonatal outcomes for IVF multiples may extend into later childhood.
Purpose of the Study:
- To investigate whether children born from in vitro fertilization (IVF) multiples generate higher hospital costs compared to IVF singletons from birth up to age five.
- To analyze the cost differences between IVF multiples and singletons across different life stages up to age five.
Main Methods:
- A retrospective cohort study included 5497 children born from IVF/ICSI treatments between 2003-2005 in five Dutch centers.
- Children were stratified into low-, moderate-, or high-risk groups based on neonatal indicators.
- Hospital resource utilization data (hospitalizations, outpatient visits, procedures) were collected for 302 multiples and 278 singletons over a 5-year follow-up period.
Main Results:
- IVF multiples exhibited significantly higher risks of hospitalization (OR 4.9), outpatient visits (OR 2.6), and medical procedures (OR 1.7) compared to singletons.
- Total hospital costs from birth to age five were 3.3-fold higher for multiples (€10,018) than singletons (€2,093), largely driven by birth admission costs (€10,018 vs €2,093).
- Excluding the birth admission period, hospital costs for multiples and singletons were comparable during the first year (€1,131 vs €696) and from years two to five (€1,084 vs €938).
Conclusions:
- Hospital costs are significantly higher for IVF/ICSI multiples compared to singletons up to age five, primarily due to the birth admission period.
- Excluding birth admission costs, hospital expenditures for multiples and singletons become comparable, highlighting the impact of neonatal complications.
- Single-embryo transfer could lead to substantial healthcare savings, particularly during the birth admission phase, warranting a comparison with the costs of additional embryo transfers and overall health outcomes.
Study Question:
Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?
Summary Answer:
Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable.
What Is Known Already:
Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birthweight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.
Study Design, Size, Duration:
All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate- or high-risk).
Participants/Materials, Setting, Methods:
To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons.
Main Results And The Role Of Chance:
The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to €10 018 and €2093 during the birth admission period (P < 0.001), €1131 and €696 after the birth admission period to the first birthday (not significant (n.s.)) and €1084 and €938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P < 0.001). Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life.
Limitations, Reasons For Caution:
Resource use and costs outside the hospital were not included in the analysis.
Wider Implications Of The Findings:
This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer.
Study Funding/Competing Interests:
This study was supported by a research grant (grant number 80-82310-98-09094) from the Netherlands Organization for Health Research and Development (ZonMw). There are no conflicts of interest in connection with this article.
Trial Registration Number:
Not applicable.
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