title: Cost of transferring one through five embryos per in vitro fertilization cycle from various payor perspectives.
abstract: OBJECTIVE
  We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer.
  
  
  METHODS
  Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models stratified by maternal age subgroup. We modeled both total costs, cost-effectiveness (cost per live birth), and clinical outcomes: multiple births, preterm deliveries, and cerebral palsy.
  
  
  RESULTS
  From a societal and insurer perspective, it was least expensive to transfer one embryo. For women aged younger than 35 years, it cost society 80% more to transfer five rather than one embryo at a time (total cost 39,212 dollars compared with 21,661 dollars). For women aged older than 42 years, it cost 13% more (29,102 dollars compared with 25,723 dollars). From a parental perspective, it was least expensive to transfer between two and five embryos, depending on maternal age. One-embryo transfers markedly improved clinical outcomes. For example, two compared with one-embryo transfers for women aged younger than 35 years reduced preterm birth and cerebral palsy rates by 55% and 41%, respectively. Univariable sensitivity analysis and Monte Carlo simulation showed our results to be robust.
  
  
  CONCLUSIONS
  Transferring one embryo per cycle is the least expensive strategy from a societal perspective, especially for younger women, yet it is the most expensive option from a parental perspective. To reduce in vitro fertilization-associated multiple birth rates, public policy must address these disparate financial incentives.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA. sarah.little@ucsf.edu
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Little
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ratcliffe
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004624:Embryo Transfer / Q000191:economics*; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008423:Maternal Age; D009010:Monte Carlo Method; D009099:Multiple Birth Offspring; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000453:epidemiology; D014481:United States / Q000453:epidemiology