Human Reproduction Vol.21, No.8 pp. 2090–2097, 2006
Advance Access publication April 13, 2006.
Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial Audrey A.A.Fiddelers1,4, Aafke P.A.van Montfoort2, Carmen D.Dirksen1, John C.M.Dumoulin2, Jolande A.Land2, Gerard A.J.Dunselman2, J.Marij Janssen2, Johan L.Severens1,3 and Johannes L.H.Evers2 1
Department of Clinical Epidemiology and Medical Technology Assessment, 2Department of Obstetrics and Gynaecology, Academic Hospital Maastricht and 3Department of Health Organisation, Policy, and Economics, University Maastricht, Maastricht, The Netherlands
To whom correspondence should be addressed at: Department of Clinical Epidemiology and Medical Technology Assessment, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: [email protected]
Key words: cost-effectiveness/randomized clinical trial/single embryo transfer
Introduction One of the most important complications of infertility treatments is the high percentage of multiple pregnancies. In 2001, of all IVF pregnancies in Europe, 24.0% were twin pregnancies (Andersen et al., 2005) compared with 1.2% twin pregnancies after natural conception (ESHRE Capri Workshop Group, 2000). Twin pregnancies are considered high-risk pregnancies for both mother and infants because of the relative high incidence in obstetric, perinatal and neonatal complications, which at the same time lead to high health care costs. Up till now, five studies have been performed on the cost-effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) (Wolner-Hanssen and Rydhstroem, 1998; De Sutter et al., 2002; Gerris et al., 2004; Lukassen et al., 2005; Thurin Kjellberg et al., 2006). One study from Sweden used a hypothetical take-home baby rate after SET and empirical pregnancy rates after DET to compare costs per successful pregnancy (Wolner-Hanssen and Rydhstroem, 1998). Another study from Belgium (De Sutter et al., 2002) used a Markov model to estimate cost-effectiveness of eSET versus DET, in which pregnancy probabilities for eSET and DET were based on results from other studies, and
costs were based on data from a local hospital. In a study by Gerris et al. (2004), also from Belgium, the cost-effectiveness of eSET and DET was compared by offering patients the choice of eSET, in case one good quality embryo was available, and DET, irrespective of embryo quality. Furthermore, in a Dutch study by Lukassen et al. (2005), the cost-effectiveness of two cycles eSET was compared with one cycle DET after randomization, in case two embryos were available of which one was of good quality. Finally, in a Scandinavian study by Thurin Kjellberg (Thurin Kjellberg et al., 2006), the costeffectiveness of one cycle eSET and one cycle DET was compared, in case two good quality embryos were available in patients