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Published on: September 16, 2021
Cost-Effectiveness of the Freeze-All Policy
Matheus Roque1, Marcello Valle1, Fernando Guimarães1
1ORIGEN - Center for Reproductive Medicine, Rio de Janeiro/RJ - Brazil.
Insights
Freeze-all cycles are more cost-effective than fresh embryo transfers, offering a higher pregnancy rate and lower overall treatment costs. This strategy improves outcomes in assisted reproductive technology.
Area of Science:
- Reproductive Endocrinology
- Health Economics
- In Vitro Fertilization (IVF)
Background:
- Fresh embryo transfer has been the standard in IVF.
- Concerns exist regarding the impact of ovarian stimulation on the endometrium for fresh transfer.
- Freeze-all cycles offer a potential alternative for optimizing implantation rates.
Purpose of the Study:
- To compare the cost-effectiveness of freeze-all cycles versus fresh embryo transfer.
- To analyze pregnancy rates and treatment costs associated with each strategy.
Main Methods:
- Observational study with cost-effectiveness analysis of 530 intracytoplasmic sperm injection (ICSI) cycles.
- Compared 351 fresh embryo transfers with 179 freeze-all cycles using a GnRH antagonist protocol.
- Two cost-effectiveness scenarios were analyzed, including all associated treatment expenses.
Main Results:
- The freeze-all group demonstrated a higher pregnancy rate (39.7%) compared to the fresh group (31.1%).
- Cost per pregnancy was significantly lower in freeze-all cycles ($19,156.73) versus fresh cycles ($23,059.72).
- Even when accounting for all cryopreservation and frozen-thawed embryo transfer costs, freeze-all remained more cost-effective.
Conclusions:
- A freeze-all policy is a more cost-effective strategy than fresh embryo transfer.
- This approach enhances the economic viability of assisted reproductive technologies.
- Freeze-all cycles represent an efficient strategy for improving IVF outcomes.
Objective:
To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer.
Methods:
This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers.
Results:
The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy.
Conclusions:
The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.
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