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Single Embryo Transfer Versus Double Embryo Transfer: A Cost-Effectiveness Analysis in a Non-IVF Insurance Mandated

Collin Sitler¹, Michael Lustik², Gary Levy¹

¹Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Tripler Army Medical Center, 1 Jarrett White Rd Honolulu, HI 96859.

Military Medicine

|July 8, 2020

Summary

Single embryo transfer (SET) is more cost-effective than double embryo transfer (DET) for in vitro fertilization (IVF) in U.S. military facilities, saving millions despite higher personal costs for SET. This finding supports a shift in practice patterns.

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Area of Science:

Reproductive Medicine
Health Economics
In Vitro Fertilization (IVF)

Background:

The American Society of Reproductive Medicine recommends single embryo transfer (SET) due to increased risks associated with multiple gestations.
Existing cost-effectiveness models for SET versus double embryo transfer (DET) often exclude maternal and neonatal morbidity and have not been evaluated within U.S. military healthcare facilities.

Purpose of the Study:

To determine the cost-effectiveness of sequential SET compared to DET within a U.S. military treatment facility.

Main Methods:

A cost-effectiveness model was developed using data from 250 patients (ages 20-44) who underwent IVF.
Cycle outcomes were predicted using the SARTCORS success calculator, and neonatal/obstetrical outcomes and costs were simulated based on singleton and twin pregnancies using internal data.

Main Results:

For 250 patients, SET resulted in 140 live births at a total cost of $5.7 million ($40,500 per delivery), while DET resulted in 117 live births at $9.2 million ($77,700 per delivery).
DET led to more infants (207 vs. 143), but SET had higher personal costs per patient ($23,036 vs. $20,535).

Conclusions:

SET offers significant cost savings of approximately $3.5 million per 250 patients in a system without infertility coverage.
Despite higher personal costs, the substantial overall system savings associated with SET warrant consideration for practice pattern changes within the U.S. Military Healthcare System.