title: Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI.
abstract: OBJECTIVE
  Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5?
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  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 birthweight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life.
  
  
  METHODS
  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).
  
  
  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.
  
  
  RESULTS
  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 €10 018 and €2093 during the birth admission period (P < 0.001), €1131 and €696 after the birth admission period to the first birthday (not significant (n.s.)) and €1084 and €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.
  
  
  CONCLUSIONS
  Resource use and costs outside the hospital were not included in the analysis.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  This study was supported by a research grant (grant number 80-82310-98-09094) from the Netherlands Organization for Health Research and Development (ZonMw). There are no conflicts of interest in connection with this article.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands mirjam.van.heesch@mumc.nl.
authors.forename: M M J
authors.initials: MM
authors.lastname: van Heesch
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: J L H
authors.initials: JL
authors.lastname: Evers
authors.affiliation: Department of Neonatology, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: M A H B M
authors.initials: MA
authors.lastname: van der Hoeven
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: J C M
authors.initials: JC
authors.lastname: Dumoulin
authors.affiliation: Department of Biological Psychology, VU University, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
authors.forename: C E M
authors.initials: CE
authors.lastname: van Beijsterveldt
authors.affiliation: Department of Obstetrics and Prenatal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Midwifery Academy Rotterdam, Rochussenstraat 198, Rotterdam 3015 EK, The Netherlands Department of Public Health, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Bonsel
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: Dykgraaf
authors.affiliation: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands Department of Pediatrics, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, Utrecht 3508 AB, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Koopman-Esseboom
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: W L D M
authors.initials: WL
authors.lastname: Nelen
authors.affiliation: Department of Neonatology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Steiner
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Tamminga
authors.affiliation: Academic Medical Center, Center of Reproductive Medicine, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Tonch
authors.affiliation: Department of Reproductive Medicine, University Medical Center Utrecht, PO Box 85090, Utrecht 3508 AB, The Netherlands.
authors.forename: H L
authors.initials: HL
authors.lastname: Torrance
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D002675:Child, Preschool; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics* / Q000379:methods; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009099:Multiple Birth Offspring; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: assisted reproduction; child follow-up; hospital costs; multiple pregnancy