title: Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial.
abstract: BACKGROUND
  Twin pregnancies after IVF are still frequent and are considered high-risk pregnancies leading to high costs. Transferring one embryo can reduce the twin pregnancy rate. We compared cost-effectiveness of one fresh cycle elective single embryo transfer (eSET) versus one fresh cycle double embryo transfer (DET) in an unselected patient population.
  
  
  METHODS
  Patients starting their first IVF cycle were randomized between eSET and DET. Societal costs per couple were determined empirically, from hormonal stimulation up to 42 weeks after embryo transfer. An incremental cost-effectiveness ratio (ICER) was calculated, representing additional costs per successful pregnancy.
  
  
  RESULTS
  Successful pregnancy rates were 20.8% for eSET and 39.6% for DET. Societal costs per couple were significantly lower after eSET (7334 euro) compared with DET (10,924 euro). The ICER of DET compared with eSET was 19,096 euro, meaning that each additional successful pregnancy in the DET group will cost 19,096 euro extra.
  
  
  CONCLUSIONS
  One cycle eSET was less expensive, but also less effective compared to one cycle DET. It depends on the society's willingness to pay for one extra successful pregnancy, whether one cycle DET is preferred from a cost-effectiveness point of view.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital Maastricht, The Netherlands. afi@kemta.azm.nl
authors.forename: Audrey A A
authors.initials: AA
authors.lastname: Fiddelers
authors.forename: Aafke P A
authors.initials: AP
authors.lastname: van Montfoort
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.forename: John C M
authors.initials: JC
authors.lastname: Dumoulin
authors.forename: Jolande A
authors.initials: JA
authors.lastname: Land
authors.forename: Gerard A J
authors.initials: GA
authors.lastname: Dunselman
authors.forename: J Marij
authors.initials: JM
authors.lastname: Janssen
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Johannes L H
authors.initials: JL
authors.lastname: Evers
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004624:Embryo Transfer / Q000191:economics*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D017048:Health Care Costs; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011272:Pregnancy, Multiple; D014427:Twins