COST-UTILITY ANALYSIS OF TRANSFERRING ONE THROUGH FIVE EMBRYOS PER IN VITRO FERTILIZATION CYCLE
Sarah Little, AB1, Jennifer Ratcliffe, MD, PhD2, and Aaron B. Caughey, MD, MPP, MPH1. (1) UCSF, San Francisco, CA, (2) Advanced Fertility Associates, Santa Rosa, CA
Purpose: We sought to analyze the outcomes and cost-utility of transferring between 1 and 5 embryos per in vitro fertilization (IVF) cycle. Methods: Data from the 2003 Assisted Reproductive Technology Report and literature review was used to create Markov decision analytic models stratified by maternal age subgroup. The models compared transfer of between 1 and 5 embryos per IVF treatment cycle and accounted for both fresh and frozen embryo transfers from non-donor eggs. Baseline analysis allowed for a maximum of 5 IVF treatment cycles. Clinical outcomes included gestational number, preterm birth, and neonatal morbidity (cerebral palsy). A decision analysis was performed using discounted maternal quality-adjusted life-years (QALYs). Cost-utility analysis was performed from a societal perspective. Sensitivity analysis and Monte Carlo simulation were used to test for robustness. Results: For women under age 35, total QALYs increased slightly with increasing number of embryos transferred (Table). This increase was not cost-effective at $191,000 per QALY for 2 as compared to 1-embryo transfers. 1-embryo transfers became relatively more effective when increasing the maximum allowable IVF treatment cycles. At 10 allowable cycles, 1-embryo transfers were the most effective, and thus the dominant strategy in cost-utility analysis. For older women, however, transferring more embryos led to a relatively greater effectiveness advantage. For women over 42, increasing the number of embryos was incrementally cost-effective ranging from $7,000 to $20,000 per QALY for each additional embryo transferred. Conclusions: Transferring more than 1 embryo per IVF treatment cycle is not a cost-effective strategy for women under the age of 35. However, multiple embryo transfers become more cost-effective with increasing maternal age. Additionally, for younger women the decision analytic and cost-effectiveness results are improved by increasing the number of allowable IVF treatment cycles.