Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years' follow-up in England.
Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years' follow-up in England.
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辅助生殖技术（ART）出生的长期医疗保健利用和成本：一项创纪录的联系研究，并在英格兰进行了10年的随访。
DOI：
10.1093/humrep/dead198
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发表时间：
2023-12-04
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在英格兰，ART后出生的儿童的长期医疗保健利用率是否比没有生育问题的母亲所生的儿童更昂贵？与没有生育问题的母亲所生的儿童相比，ART后出生的儿童在出生后10年内有更多的全科医生（GP）咨询和更高的初级保健费用，出生后第一年的住院费用显着更高。有证据表明，ART后出生的儿童不良出生结局的风险增加，儿童期罕见不良结局的风险略有增加。我们进行了一项纵向研究368088母亲和婴儿对在英格兰使用定制的链接数据集。1997-2018年出生的单胎婴儿及其母亲在英国全科医生诊所登记，为临床实践研究数据链（CPRD）提供数据，通过CPRD GOLD母婴数据集进行识别;该数据通过与母亲的人类受精和胚胎学管理局（HFEA）登记数据的进一步联系得到增强。通过母亲的记录确定了四组婴儿：“生育”对照组，“未治疗的亚生育”组，“排卵诱导”组和ART组。婴儿从出生至2021年2月28日接受随访，除非因失访（例如离开全科医生执业、移民）或死亡而删失。CPRD从英国的全科医生网络收集匿名编码的患者电子健康记录。我们使用CPRD GOLD数据和相关的医院事件统计（HES）入院患者护理（APC）数据估计了四个生育组中婴儿的初级保健费用和住院费用。采用线性回归分析比较各组的护理费用。生成逆概率权重，并应用于调整因失访导致的损耗引起的潜在偏倚。在整个10年的随访中，与其他组相比，没有生育问题的母亲所生的孩子的咨询次数明显减少，初级保健费用也较低。关于住院费用，与没有生育问题的母亲所生的儿童相比，ART后出生的儿童在出生后第一年的住院费用显着更高（差异= £307（95%CI：153，477））。在未经治疗的低生育力和促排卵后出生的儿童中观察到相同的模式。HFEA链接仅使用非捐助者数据周期，并且引入同意数据使用减少了2009年后HFEA记录的可用性。生育力组是通过使用来自初级保健记录的证据扩充HFEA数据得出的;然而，暴露组仍存在一些潜在的错误分类。新生儿重症监护的成本未记录在HES APC数据中，这可能会导致低估对照组和不孕症组之间的成本差异。这些发现可以帮助预测与生育力低下和ART相关的医疗保健系统的财务影响，特别是随着这些治疗需求的增长。C.C.这项工作由英国医学研究理事会职业发展奖[MR/L019671/1]和英国MRC过渡支持奖[MR/W 029286/1]资助。X. H.是澳大利亚国家健康和医学研究理事会（NHMRC）新兴领导研究员[授权号2009253]。作者声明没有竞争利益。N/A.
Is the long-term health care utilization of children born after ART more costly to the healthcare system in England than children born to mothers with no fertility problems? Children born after ART had significantly more general practitioner (GP) consultations and higher primary care costs up to 10 years after birth, and significantly higher hospital admission costs in the first year after birth, compared to children born to mothers with no fertility problems. There is evidence that children born after ART are at an increased risk of adverse birth outcomes and a small increased risk of rare adverse outcomes in childhood. We conducted a longitudinal study of 368 088 mother and baby pairs in England using a bespoke linked dataset. Singleton babies born 1997–2018, and their mothers, who were registered at GP practices in England contributing data to the Clinical Practice Research Datalink (CPRD), were identified through the CPRD GOLD mother–baby dataset; this data was augmented with further linkage to the mothers’ Human Fertilisation and Embryology Authority (HFEA) Register data. Four groups of babies were identified through the mothers’ records: a ‘fertile’ comparison group, an ‘untreated sub-fertile’ group, an ‘ovulation induction’ group, and an ART group. Babies were followed-up from birth to 28 February 2021, unless censored due to loss to follow-up (e.g. leaving GP practice, emigration) or death. The CPRD collects anonymized coded patient electronic health records from a network of GPs in the UK. We estimated primary care costs and hospital admission costs for babies in the four fertility groups using the CPRD GOLD data and the linked Hospital Episode Statistics (HES) Admitted Patient Care (APC) data. Linear regression was used to compare the care costs in the different groups. Inverse probability weights were generated and applied to adjust for potential bias caused by attrition due to loss to follow-up. Children born to mothers with no fertility problems had significantly fewer consultations and lower primary care costs compared to the other groups throughout the 10-years’ follow up. Regarding hospital costs, children born after ART had significantly higher hospital admission costs in the first year after birth compared to those born to mothers with no fertility problems (difference = £307 (95% CI: 153, 477)). The same pattern was observed in children born after untreated subfertility and ovulation induction. HFEA linkage uses non-donor data cycles only, and the introduction of consent for data use reduced the availability of HFEA records after 2009. The fertility groups were derived by augmenting HFEA data with evidence from primary care records; however, there remains some potential misclassification of exposure groups. The cost of neonatal critical care is not captured in the HES APC data, which may cause underestimation of the cost differences between the comparison group and the infertility groups. The findings can help anticipate the financial impact on the healthcare system associated with subfertility and ART, particularly as the demand for these treatments grows. C.C. and this work were funded by a UK Medical Research Council Career Development Award [MR/L019671/1] and a UK MRC Transition Support Award [MR/W029286/1]. X.H. is an Australia National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow [grant number 2009253]. The authors declare no competing interest. N/A.
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影响因子：
3.7
作者：
Springate, David A.;Kontopantelis, Evangelos;Reeves, David
通讯作者：
Reeves, David
影响因子：
6.7
作者：
Declercq, Eugene;Luke, Barbara;Belanoff, Candice;Cabral, Howard;Diop, Hafsatou;Gopal, Daksha;Hoang, Lan;Kotelchuck, Milton;Stern, Judy E.;Hornstein, Mark D.
通讯作者：
Hornstein, Mark D.
影响因子：
5.4
作者：
Hernán, MA;Hernández-Díaz, S;Robins, JM
通讯作者：
Robins, JM
影响因子：
2.9
作者：
Bahadur, Gulam;Homburg, Roy;Jauniaux, Eric
通讯作者：
Jauniaux, Eric
影响因子：
6.1
作者：
Carson, C.;Sacker, A.;Quigley, M. A.
通讯作者：
Quigley, M. A.