Cost-effectiveness of 'immediate IVF' versus 'delayed IVF': a prospective study
M J C Eijkemans1,2, F A M Kersten3, A M E Lintsen3
1Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Human Reproduction (Oxford, England)
|February 17, 2017
Summary
The cost-effectiveness of immediate in vitro fertilization (IVF) varies significantly based on infertility diagnosis and female age. Unexplained infertility is most costly, while endometriosis offers better value for money with immediate IVF treatment.
Area of Science:
- Reproductive Medicine and Economics
- Health Technology Assessment
- Infertility Treatment Cost-Effectiveness
Background:
- Existing guidelines for in vitro fertilization (IVF) indications consider diagnostic category, female age, and infertility duration.
- The cost-effectiveness (CE) of these guidelines is largely unknown, with limited evidence for most diagnostic categories beyond bilateral tubal occlusion.
Purpose of the Study:
- To determine how the cost-effectiveness (CE) of immediate in vitro fertilization (IVF) compared to postponing IVF for one year is influenced by couple prognostic characteristics.
- To analyze the CE ratio (incremental costs per extra live birth) for immediate versus delayed IVF across different prognostic factors.
Main Methods:
- A modeling approach was employed, integrating literature data and a prospective cohort study of 5962 couples eligible for IVF/ICSI.
- Data were collected from a national waiting list in The Netherlands (2002-2003), estimating natural and IVF pregnancy chances.
- Cost-effectiveness was compared between immediate IVF versus a one-year delay, stratified by female age, infertility duration, and diagnostic category.
Main Results:
- The gain in live birth rate with immediate IVF increased with female age, irrespective of diagnostic category or infertility duration.
- Increased costs for immediate IVF were primarily dependent on diagnostic category and infertility duration.
- The lowest CE ratio (<€10,000/live birth) was observed for endometriosis from age 34 with 1-year duration; the highest (€56,000/live birth) for unexplained infertility at age 30 with 3-year duration.
Conclusions:
- The cost-effectiveness of IVF timing is influenced by societal willingness to pay, woman's age, and diagnostic category.
- Current guidelines should incorporate natural conception probabilities before deciding on IVF treatment timing.
- The study excluded frozen embryo transfers, representing a limitation in fully assessing IVF cost-effectiveness.
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