USING LARGE, RETROSPECTIVE DATASETS TO MAKE COST-EFFECTIVE DECISIONS CONCERNING EMBRYO TRANSFER POLICIES IN FIRST CYCLE IN VITRO FERTILIZATION PATIENTS WHO ARE 38 YEARS OF AGE OR OLDER: A POPULATION-BASED ANALYSIS

Purpose: There appears to be considerable heterogeneity in terms of effectiveness measures in fertility treatments including in-vitro fertilization (IVF). When the denominator becomes a healthy live birth event, defined as a baby (or babies) surviving through 27 days post-delivery, the cost-intensive variables can be bifurcated between treatment costs, and perinatal outcome costs measured from the antepartum period onwards to the first 5 years of life. The purpose of this study is to look at the difference in cost and multiple birth rate between single vs. double embryo transfer in relation to the above parameters and determine the incremental cost per additional live birth event between the two groups.

Method: Retrospective data analysis from the 1991-1998 Human Fertilisation and Embryology Authority (HFEA) database in the United Kingdom.

Result: Among 1,270 women receiving single embryo transfers (SET) who were aged 38 years or older, and who were new presenters (on their first treatment cycle), there were a total of 71 live birth events comprising 69 singletons, 1 set of twins and 1 set of triplets, which is an extraordinarily rare event. Moving patients who received SET to a theoretical double embryo transfer (DET) treatment was estimated to increase the live birth rate by a factor of 2.7 (0.06 vs. 0.16, p < 0.05), at the expense of a five-fold increase in the predicted incidence of multiple births (2.82% vs. 13.89%). This was based on the actual live birth rates and multiple birth rates for patients who received DET, applied to patients who otherwise received SET on their final IVF treatment cycle, irrespective of the number and duration of each treatment cycle. The incremental cost per additional live birth event in moving to a 2ET policy in the one cycle population was £3,429 ($7468 after inflation adjustment as of 2011) in the nominal scenario. An extreme scenario sensitivity analysis showed that this value ranged from £3,336 ($7265) to £3,525 ($7676) in the minimum and maximum scenarios, respectively.

Conclusion: Our model, showing the interaction between two competing, cost-intensive episodes of care (IVF treatment and NICU outcomes) provides a solid basis for future research on more current datasets.