A health-economic decision-analytic model comparing double with single embryo transfer in IVF/ICSI: a sensitivity analysis

Paul De Sutter1,3, Jan Gerris2 and Marc Dhont1

1 Infertility Centre, Department of Obstetrics and Gynecology, University Hospital, Gent, and 2 Centre for Reproductive Medicine, Middelheim Hospital, Antwerp, Belgium

3 To whom correspondence should be addressed. e-mail: Paul.desutter{at}rug.ac.be

Dear Sir,

We would like to append a sensitivity analysis to our article recently published in your journal (De Sutter et al., 2002Go). In short, we previously demonstrated that the cost per live-born child is similar whether one or two embryos are transferred in IVF or ICSI cycles. The extra cycles needed with single embryo transfer (SET) to obtain the same number of children constitutes an extra cost, which is compensated for by the increase in neonatal care expenses due to the extra twins in the double embryo transfer (DET) group. We have shown that the usage of pregnancy rates from different published randomized as well as non-randomized studies did not alter the conclusion reached by our model.

The question may be asked how the results of the model would be affected when varying the different cost parameters. In a situation where (only) IVF costs would increase, the total cost would obviously increase as well, both for the SET and the DET strategy. It can be seen from Figure 1 that the cost per live-born child would increase more rapidly for SET than for DET, indicating that in that scenario SET would become less cost-efficient than DET. However, if the model is run using increased IVF costs in conjunction with proportionally increased costs for neonatal care, the total costs will again increase, but at all instances the cost per-child-born remains the same for SET and for DET (Figure 2). It can be expected that in some countries IVF costs as well as neonatal care expenses are higher than the figures used in our model, but the present sensitivity analysis shows that this does not affect the conclusion of our model. We are strongly convinced that in all instances SET is to be preferred over DET in good prognosis patients, not only from a medical and an ethical, but also from a health-economic point of view.



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Figure 1. Correlation between IVF costs and total cost per live-born child for SET and DET.

 


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Figure 2. Correlation between IVF costs and total cost per live-born child for SET and DET, taking into account increases in neonatal care expenses, proportionally to IVF costs.

 

References

De Sutter, P., Gerris, J. and Dhont, M. (2002) A health-economic decision-analytic model comparing double with single embryo transfer in IVF/ICSI. Hum. Reprod., 17, 2891–2896.[Abstract/Free Full Text]