Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI
Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI
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DOI：
10.1093/humrep/dev059
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发表时间：
2015-06-01
影响因子：
6.1
通讯作者：
Dirksen, C. D.
中科院分区：
文献类型：
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作者：
van Heesch, M. M. J.;Evers, J. L. H.;Dirksen, C. D.
研究问题：从出生到5岁，多胎体外受精（IVF）是否比单胎体外受精产生更高的医院费用？回答：与IVF/ICSI单胎相比，IVF/ICSI多胎儿童从出生到5岁的住院费用显著高于IVF/ICSI单胎；然而，当排除分娩住院期间发生的费用时，多胞胎和单胞胎的住院费用具有可比性。已知情况：人们对体外受精后出生的孩子的长期后果越来越担忧。由于双胚胎移植，体外受精中多胎的发生率增加，使儿童易患较差的新生儿结局，如早产和低出生体重。因此，试管婴儿需要更多的医疗护理。多胞胎新生儿预后较差的成本和后果也可能在以后的生活中存在。研究设计、规模、持续时间：所有5497名2003-2005年IVF出生的儿童，其父母在五个参与的荷兰IVF中心之一接受IVF或ICSI治疗，作为回顾性队列研究的基础。根据胎龄、出生体重、Apgar和先天性畸形，将儿童分为三个风险层（低、中、高风险）。参与者/材料、环境、方法：为提高数据收集效率，采用分层（风险）抽样法，选取816例多胞胎和584例单胞胎进行5年随访。共收到322例多胞胎和293例单胞胎的家长知情同意书。从医院信息系统和患者图表中检索了302名多胞胎和278名单胞胎的个人层面医院资源使用数据（住院、门诊就诊和医疗程序）。主要结果和偶然性的作用：多胞胎的住院风险（OR 4.9, 95% CI 3.3-7.0）、门诊就诊风险（OR 2.6, 95% CI 1.8-3.6）和医疗程序风险（OR 1.7, 95% CI 1.2-2.2）高于单胞胎。在出生入院期间，平均住院费用分别为（原文如此）10018和2093 (P < 0.001)，在出生入院期间至一周岁之后（原文如此）1131和696（无统计学意义（注）），从第二至第五个生命年（注）（原文如此）1084和938（原文如此）。多胞胎从出生到5岁的住院费用是单胞胎的3.3倍（P < 0.001）。在多胞胎和单胞胎中，住院天数分别占总住院费用的90.8%和76.2%，前5年总住院费用的8.9和25.2%发生在出生后1年。局限性和注意原因：医院外的资源使用和成本未包括在分析中。研究结果的更广泛意义：本研究证实，与IVF/ICSI单胎相比，IVF/ICSI多胎增加了医疗资源的使用。单胚胎移植可以节省大量费用，特别是在分娩入院期间。这些节省需要与成功怀孕所需的额外胚胎移植的额外费用进行比较。除了费用外，单胚胎移植后出生的孩子的健康结果应该与双胚胎移植后出生的孩子进行比较。
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.