Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI

M.M.J. van Heesch, J.L.H. Evers, M.A.H.B.M. van der Hoeven, J.C.M. Dumoulin, C.E.M. van Beijsterveldt, G.J. Bonsel, R.H.M. Dykgraaf, J.B. van Goudoever, C. Koopman-Esseboom, W.L.D.M. Nelen, K. Steiner, P. Tamminga, N. Tonch, H.L. Torrance, C.D. Dirksen

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?

SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable.

WHAT IS KNOWN ALREADY: Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birth-weight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.

STUDY DESIGN, SIZE, DURATION: All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate-or high-risk).

PARTICIPANTS/MATERIALS, SETTING, METHODS: To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons.

MAIN RESULTS AND THE ROLE OF CHANCE: The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to (sic)10 018 and (sic)2093 during the birth admission period (P <0.001), (sic)1131 and (sic)696 after the birth admission period to the first birthday (not significant (n.s.)) and (sic)1084 and (sic)938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P <0.001). Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life.

LIMITATIONS, REASONS FOR CAUTION: Resource use and costs outside the hospital were not included in the analysis.

WIDER IMPLICATIONS OF THE FINDINGS: This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer.

Original languageEnglish
Pages (from-to)1481-1490
Number of pages10
JournalHuman Reproduction
Volume30
Issue number6
DOIs
Publication statusPublished - Jun 2015

Keywords

  • assisted reproduction
  • multiple pregnancy
  • child follow-up
  • hospital costs
  • ASSISTED REPRODUCTIVE TECHNOLOGY
  • IN-VITRO FERTILIZATION
  • DANISH NATIONAL COHORT
  • PRETERM BIRTH
  • CARE UTILIZATION
  • EMBRYO-TRANSFER
  • CHILDREN BORN
  • INFANTS
  • RISK
  • PREGNANCIES

Cite this

van Heesch, M.M.J. ; Evers, J.L.H. ; van der Hoeven, M.A.H.B.M. ; Dumoulin, J.C.M. ; van Beijsterveldt, C.E.M. ; Bonsel, G.J. ; Dykgraaf, R.H.M. ; van Goudoever, J.B. ; Koopman-Esseboom, C. ; Nelen, W.L.D.M. ; Steiner, K. ; Tamminga, P. ; Tonch, N. ; Torrance, H.L. ; Dirksen, C.D. / Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI. In: Human Reproduction. 2015 ; Vol. 30, No. 6. pp. 1481-1490.
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abstract = "STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable.WHAT IS KNOWN ALREADY: Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birth-weight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.STUDY DESIGN, SIZE, DURATION: All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate-or high-risk).PARTICIPANTS/MATERIALS, SETTING, METHODS: To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons.MAIN RESULTS AND THE ROLE OF CHANCE: The risk of hospitalization (OR 4.9, 95{\%} CI 3.3-7.0), outpatient visits (OR 2.6, 95{\%} CI 1.8-3.6) and medical procedures (OR 1.7, 95{\%} CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to (sic)10 018 and (sic)2093 during the birth admission period (P <0.001), (sic)1131 and (sic)696 after the birth admission period to the first birthday (not significant (n.s.)) and (sic)1084 and (sic)938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P <0.001). Among multiples and singletons, respectively, 90.8 and 76.2{\%} of the total hospital costs were caused by hospital admission days and 8.9 and 25.2{\%} of the total hospital costs during the first 5 years of life occurred after the first year of life.LIMITATIONS, REASONS FOR CAUTION: Resource use and costs outside the hospital were not included in the analysis.WIDER IMPLICATIONS OF THE FINDINGS: This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer.",
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year = "2015",
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doi = "10.1093/humrep/dev059",
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journal = "Human Reproduction",
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van Heesch, MMJ, Evers, JLH, van der Hoeven, MAHBM, Dumoulin, JCM, van Beijsterveldt, CEM, Bonsel, GJ, Dykgraaf, RHM, van Goudoever, JB, Koopman-Esseboom, C, Nelen, WLDM, Steiner, K, Tamminga, P, Tonch, N, Torrance, HL & Dirksen, CD 2015, 'Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI', Human Reproduction, vol. 30, no. 6, pp. 1481-1490. https://doi.org/10.1093/humrep/dev059

Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI. / van Heesch, M.M.J.; Evers, J.L.H.; van der Hoeven, M.A.H.B.M.; Dumoulin, J.C.M.; van Beijsterveldt, C.E.M.; Bonsel, G.J.; Dykgraaf, R.H.M.; van Goudoever, J.B.; Koopman-Esseboom, C.; Nelen, W.L.D.M.; Steiner, K.; Tamminga, P.; Tonch, N.; Torrance, H.L.; Dirksen, C.D.

In: Human Reproduction, Vol. 30, No. 6, 06.2015, p. 1481-1490.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI

AU - van Heesch, M.M.J.

AU - Evers, J.L.H.

AU - van der Hoeven, M.A.H.B.M.

AU - Dumoulin, J.C.M.

AU - van Beijsterveldt, C.E.M.

AU - Bonsel, G.J.

AU - Dykgraaf, R.H.M.

AU - van Goudoever, J.B.

AU - Koopman-Esseboom, C.

AU - Nelen, W.L.D.M.

AU - Steiner, K.

AU - Tamminga, P.

AU - Tonch, N.

AU - Torrance, H.L.

AU - Dirksen, C.D.

PY - 2015/6

Y1 - 2015/6

N2 - STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable.WHAT IS KNOWN ALREADY: Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birth-weight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.STUDY DESIGN, SIZE, DURATION: All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate-or high-risk).PARTICIPANTS/MATERIALS, SETTING, METHODS: To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons.MAIN RESULTS AND THE ROLE OF CHANCE: The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to (sic)10 018 and (sic)2093 during the birth admission period (P <0.001), (sic)1131 and (sic)696 after the birth admission period to the first birthday (not significant (n.s.)) and (sic)1084 and (sic)938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P <0.001). Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life.LIMITATIONS, REASONS FOR CAUTION: Resource use and costs outside the hospital were not included in the analysis.WIDER IMPLICATIONS OF THE FINDINGS: This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer.

AB - STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable.WHAT IS KNOWN ALREADY: Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birth-weight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.STUDY DESIGN, SIZE, DURATION: All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate-or high-risk).PARTICIPANTS/MATERIALS, SETTING, METHODS: To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons.MAIN RESULTS AND THE ROLE OF CHANCE: The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to (sic)10 018 and (sic)2093 during the birth admission period (P <0.001), (sic)1131 and (sic)696 after the birth admission period to the first birthday (not significant (n.s.)) and (sic)1084 and (sic)938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P <0.001). Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life.LIMITATIONS, REASONS FOR CAUTION: Resource use and costs outside the hospital were not included in the analysis.WIDER IMPLICATIONS OF THE FINDINGS: This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer.

KW - assisted reproduction

KW - multiple pregnancy

KW - child follow-up

KW - hospital costs

KW - ASSISTED REPRODUCTIVE TECHNOLOGY

KW - IN-VITRO FERTILIZATION

KW - DANISH NATIONAL COHORT

KW - PRETERM BIRTH

KW - CARE UTILIZATION

KW - EMBRYO-TRANSFER

KW - CHILDREN BORN

KW - INFANTS

KW - RISK

KW - PREGNANCIES

U2 - 10.1093/humrep/dev059

DO - 10.1093/humrep/dev059

M3 - Article

VL - 30

SP - 1481

EP - 1490

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - 6

ER -