Economic evaluation of embryo transfer strategies in in vitro fertilization (IVF): a systematic review

This study aims to systematically review the economic evaluations of various embryo transfer strategies, including single embryo transfer (SET), double embryo transfer (DET) and others in IVF.

Web of Science, Scopus, PubMed, Embase, and the NHS Economic Evaluation Database were searched since January 1980 to 1 October 2023. Full economic evaluations comparing embryo transfer strategies were included; while review articles, editorials, abstracts, and non-English articles were excluded. The CHEERS 2022 checklist was used to assess the quality of the included studies.

Out of 4,336 records, 16 studies were included, mostly from Europe (75%), with a few from North America (19%) and Asia (6%). Most studies (94%) assessed the cost-effectiveness of SET versus DET using cost-effectiveness analysis (CEA), one study (6%) used cost-utility analysis (CUA). The Markov model was most common, with some using decision-tree or other modeling approaches. Study perspectives were societal (50%), healthcare system (25%), service provider (12.5%), or insurer (12.5%). The most reported outcomes were live birth rate (50%) and incremental cost per live birth (56%), while other outcomes, such as expected life years or quality-adjusted life years were less frequently reported.

Findings indicate that SET and SET-based strategies, such as combining fresh and frozen SET cycles or mild stimulation protocols, are often more cost-effective than DET and other strategies, especially among younger women, by reducing maternal and neonatal complications and long-term healthcare costs. Cost-effectiveness, however, varies by maternal age, healthcare system context, modeling approach, patient preferences, and societal willingness-to-pay thresholds. Most evidence comes from high-income countries, but the findings provide insights to guide evidence-based embryo transfer decisions that balance clinical effectiveness, patient preferences, and economic sustainability.