Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology
Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology
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DOI：
10.1001/jamapediatrics.2014.1357
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发表时间：
2014-11-01
期刊：
影响因子：
26.1
通讯作者：
Chapman, Michael
中科院分区：
文献类型：
--
作者：
Chambers, Georgina M.;Van Phuong Hoang;Chapman, Michael
重要性在过去的30年中，多胞胎的空前增加是一个主要的公共卫生问题，并与医疗辅助受孕的吸收平行。对单胎、双胎和高阶多胎（HOM）儿童在出生后5年内住院的频率、持续时间和费用进行全面的经济和卫生服务评估，并研究辅助生殖技术（ART）对多胎分娩的发生率和费用的贡献。一项回顾性人群队列研究，使用1993年10月至2003年9月在西澳大利亚州出生的233850名婴儿的出生、住院和死亡记录，并随访至2008年9月。结果在226624名单胎、6941名双胎和285名HOM婴儿中，1.0%的单胎、15.4%的双胎和34.7%的HOM儿童是在ART后受孕的。与单胎相比，双胞胎和HOM分别是3.4和9.6倍，更有可能是死产和6.4和36.7倍，更有可能在新生儿期死亡。双胞胎和HOM分别是18.7和525.1倍，更有可能是早产，3.6和2.8倍，更有可能是小于胎龄儿。单胎、双胎和HOM儿童至5岁的平均住院费用分别为2730美元、8993美元和24411美元（2009-2010年美元），费用差异集中在新生儿期和生命的第一年。几乎15%的住院费用多胞胎可以避免，如果ART双胞胎和HOMs已出生为singletons.CONCLUSIONS和相关性相比，单胞胎，多胞胎婴儿消耗显着更多的医院资源，特别是在新生儿期和第一年的生活。与多胞胎相关的临床和经济负担的很大一部分可以通过单胚胎移植来预防。全球范围内越来越多的ART使用和一些国家持续高的ART多胎出生率突出了鼓励单胚胎移植战略的必要性。这项研究的成本可以推广到其他环境。
IMPORTANCE The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood.OBJECTIVES To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births.DESIGN, SETTING, AND PARTICIPANTS A retrospective population cohort study using individually linked birth, hospital, and death records among 233 850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008.EXPOSURES Multiple-gestation delivery and ART conception.MAIN OUTCOMES AND MEASURES Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs.RESULTS Of 226 624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24 411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons.CONCLUSIONS AND RELEVANCE Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings.