Cost-effectiveness analysis of different embryo transfer strategies in England.
OBJECTIVE
The objective of this study was to assess the cost-effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective.


METHODS
Cost-effectiveness model.


METHODS
Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05.


METHODS
Women with two embryos available for transfer in three age groups (<30, 30-35 and 36-39 years).


METHODS
A decision analytic model was constructed using observational data collected from a sample of fertility centres in England. Costs and adverse outcomes are estimated up to 5 years after the birth. Incremental cost per live birth was calculated for different embryo transfer strategies and for three separate age groups: less than 30, 30-35 and 36-39 years.


METHODS
Premature birth, neonatal intensive care unit admissions and days, cerebral palsy and incremental cost-effectiveness ratios.


RESULTS
Single fresh embryo transfer (SET) plus frozen single embryo transfer (fzSET) is the more costly in terms of IVF costs, but the lower rates of multiple births mean that in terms of total costs, it is less costly than double embryo transfer (DET). Adverse events increase when moving from SET to SET+fzSET to DET. The probability of SET+fzSET being cost-effective decreases with age. When SET is included in the analysis, SET+fzSET no longer becomes a cost-effective option at any threshold value for all age groups studied.


CONCLUSIONS
The analyses show that the choice of embryo transfer strategy is a function of four factors: the age of the mother, the relevance of the SET option, the value placed on a live birth and the relative importance placed on adverse outcomes. For each patient group, the choice of strategy is a trade-off between the value placed on a live birth and cost.
Dixon
S
S
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. s.dixon@sheffield.ac.uk
Faghih Nasiri
F
F
Ledger
W L
WL
Lenton
E A
EA
Duenas
A
A
Sutcliffe
P
P
Chilcott
J B
JB
D000328:Adult; D017677:Age Distribution; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004624:Embryo Transfer / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000191:economics / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology