Economic evaluation of elective single embryo transfer with subsequent single frozen embryo transfer in an in vitro fertilization intracytoplasmic sperm injection program

Capsule:
The choice of elective single-embryo transfer strategy to be adopted should be determined by the context of the health system and the individual prognosis.

Authors:
Elisa Hernandez Torres, M.Sc., José Luis Navarro-Espigares, Ph.D., Ana Clavero, M.D., Ph.D., MaLuisa López-Regalado, M.Sc., Jose Antonio Camacho-Ballesta, Ph.D., MaÁngeles Onieva-García, M.Sc., Luis Martínez, M.D., Ph.D., Jose Antonio Castilla, M.D., Ph.D.

Volume 103, Issue 3, Pages 699-706

Abstract:

Objective:
To analyze the cost-effectiveness of IVF-ICSI cycles with elective single-embryo transfer (eSET), plus elective single frozen embryo transfer (eSFET) if pregnancy is not achieved, compared with double-embryo transfer (DET).

Design:
Cost-effectiveness analysis.

Setting:
Public hospital.

Patient(s):
A population of 121 women (

Intervention(s):
We conducted a cost-effectiveness analysis using the results of a prospective clinical trial. The women in group 1 received eSET plus eSFET, and those in group 2 received DET. A probabilistic sensitivity analysis was performed.

Main Outcome Measure(s):
Live birth delivery rate.

Result(s):
The cumulative live birth delivery rate was 38.60% in the eSET+eSFET group versus 42.19% in the DET group. The mean costs per patient were €5,614.11 in the eSET+eSFET group and €5,562.29 in the DET group. These differences were not statistically significant. The rate of multiple gestation was significantly lower in the eSET group than in the DET group (0 vs. 25.9%).

Conclusion(s):
This study does not show that eSET is superior to DET in terms of effectiveness or of costs. The lack of superiority of the results for the eSET+eSFET and the DET groups corroborates that the choice of strategy to be adopted should be determined by the context of the health care system and the individual prognosis.

  • Jason M. Franasiak

    A very nice study, thank you. Although sequential eSET did not yield a higher birth outcome than DET, something that might be expected given the same number of total embryos being transferred, the difference in cumulative rate and the cost were the same. Was there thought given to the fact this proves non-inferiority with a 25% reduction in multiple births (arguably the most costly component of fertility care)? That seems to be a very powerful conclusion which could be drawn from the data.

    • Ana Clavero

      Thank you for your comment. As you know, the birth weight is one of the main determinants of the costs associated with AR. Only one infant in the study weighed <1.5 kg at birth, and it was in the eSET plus eSFET group. This event had a strong impact on the costs calculated for this group, which were transferred to the sensitivity analysis by bootstrapping.

      • Jason M. Franasiak

        Thank you for your reply and explanation.

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