THE ECONOMIC-IMPACT OF MULTIPLE-GESTATION PREGNANCIES AND THE CONTRIBUTION OF ASSISTED-REPRODUCTION TECHNIQUES TO THEIR INCIDENCE
THE ECONOMIC-IMPACT OF MULTIPLE-GESTATION PREGNANCIES AND THE CONTRIBUTION OF ASSISTED-REPRODUCTION TECHNIQUES TO THEIR INCIDENCE
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DOI：
10.1056/nejm199407283310407
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发表时间：
1994-07-28
影响因子：
158.5
通讯作者：
CROWLEY, WF
中科院分区：
文献类型：
--
作者：
CALLAHAN, TL;HALL, JE;CROWLEY, WF
背景虽然与多胎妊娠相关的医疗并发症已经有了很好的记录，但很少有人知道这种妊娠对医疗保健资源的使用和相关费用的影响。这是一个重要的问题，因为越来越多地使用辅助生殖技术，这通常会导致多胎妊娠。我们决定了医院的收费和辅助生殖技术的使用（如诱导排卵、体外受精和配子输卵管内移植）（11,986例单胎妊娠，1135例双胎妊娠，85例两胎以上），在波士顿布里格姆妇女医院分娩，1986年至1991年，他们的14,033名新生儿（11,671名单胎，2144名双胎，218名来自高阶多胎妊娠）。在我们控制了已知的影响住院费用的变量之后，1991年单胎分娩的家庭预计总费用为9，845美元，而双胞胎为37，947美元（每个婴儿18，974美元），三胞胎为109，765美元（每个婴儿36，588美元）。辅助生殖技术用于2%的单胎妊娠、35%的双胎妊娠和77%的高阶多胎妊娠;这些手术在单独诱导排卵和体外受精或配子输卵管内移植之间大致相等。多胎妊娠中很大一部分是使用辅助生殖技术造成的，这大大增加了医院的收费。如果辅助生殖技术导致的所有多胎妊娠都是单胎妊娠，仅研究医院的医疗保健提供系统预计每年就可节省300多万美元。虽然辅助生殖为不孕症家庭提供了巨大的好处，但不能忽视多胎妊娠带来的医疗风险和相关费用的增加。我们建议，应更加重视减少多胎妊娠可能性的不孕症治疗方法。
Background. Although the medical complications associated with multiple-gestation pregnancies have been well documented, little is known about the effects of such pregnancies on the use of health care resources and the associated costs. This is an important issue because of the increasing use of assisted-reproduction techniques, which commonly result in multiple-gestation pregnancies.Methods. We determined hospital charges and the use of assisted-reproduction techniques (such as induction of ovulation, in vitro fertilization, and gamete intrafallopian transfer) for 13,206 pregnant women (11,986 with singleton pregnancies, 1135 with twin pregnancies, and 85 with more than two fetuses) who were admitted for delivery to Brigham and Women's Hospital, Boston, in 1986 through 1991 and their 14,033 neonates (11,671 singletons, 2144 twins, and 218 resulting from higher-order multiple gestations).Results. After we controlled for variables known to affect hospital charges, the predicted total charges to the family in 1991 for a singleton delivery were $9,845, as compared with $37,947 for twins ($18,974 per baby) and $109,765 for triplets ($36,588 per baby). Assisted-reproduction techniques were used in 2 percent of singleton, 35 percent of twin, and 77 percent of higher-order multiple-gestation pregnancies; such procedures were approximately equally divided between induction of ovulation alone and in vitro fertilization or gamete intrafallopian transfer.Conclusions. Multiple-gestation pregnancies, a high proportion of which result from the use of assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques had been singleton pregnancies, the predicted savings to the health care delivery system in the study hospital alone would have been over $3 million per year. Although assisted reproduction provides tremendous benefits to families with infertility, the increased medical risks entailed by multiple-gestation pregnancies and the associated costs cannot be ignored. We suggest that more attention be paid to approaches to infertility that reduce the likelihood of multiple gestation.