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Hum. Reprod. Advance Access published online on April 13, 2006
Human Reproduction, doi:10.1093/humrep/del112
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 1, 2006
Revised March 15, 2006
Accepted March 22, 2006

Article

Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial

Audrey A.A. Fiddelers 1 *, Aafke P.A. van Montfoort 2, Carmen D. Dirksen 3, John C.M. Dumoulin 2, Jolande A. Land 2, Gerard A.J. Dunselman 2, J. Marij Janssen 2, Johan L. Severens 4, and Johannes L.H. Evers 2

1 Department of Clinical Epidemiology and Medical Technology Assessment, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
2 Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, University Maastricht, Maastricht, The Netherlands
3 Department of Clinical Epidemiology and Medical Technology Assessment, University Maastricht, Maastricht, The Netherlands
4 Department of Clinical Epidemiology and Medical Technology Assessment; Department of Health Organisation, Policy, and Economics, University Maastricht, Maastricht, The Netherlands

* To whom correspondence should be addressed.
Audrey A.A. Fiddelers, E-mail: afi{at}kemta.azm.nl


  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 ({euro}7334) compared with DET ({euro}10 924). The ICER of DET compared with eSET was {euro}19 096, meaning that each additional successful pregnancy in the DET group will cost {euro}19 096 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.

Keywords: cost-effectiveness/randomized clinical trial/single embryo transfer.
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