Hum. Reprod. Advance Access published online on March 24, 2009
Human Reproduction, doi:10.1093/humrep/dep041
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Cost-effectiveness of seven IVF strategies: results of a Markov decision-analytic model
1 Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands 2 Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands 3 Department of Health Organisation, Policy and Economics, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands 4 Present address: Department of Anaesthesiology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands 5 Present address: Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 7900 RB Groningen, The Netherlands
6 Correspondence address. E-mail: Audrey.fiddelers{at}mumc.nl
BACKGROUND: A selective switch to elective single embryo transfer (eSET) in IVF has been suggested to prevent complications of fertility treatment for both mother and infants. We compared seven IVF strategies concerning their cost-effectiveness using a Markov model.
METHODS: The model was based on a three IVF-attempts time horizon and a societal perspective using real world strategies and data, comparing seven IVF strategies, concerning costs, live births and incremental cost-effectiveness ratios (ICERs).
RESULTS: In order to increase pregnancy probability, one cycle of eSET + one cycle of standard treatment policy [STP, i.e. eSET in patients <38 years of age with at least one good quality embryo and double embryo transfer (DET) in the remainder of patients] + one cycle of DET have an ICER of 
16 593 compared with three cycles of eSET. Furthermore, three STP cycles have an ICER of 17 636 compared with one cycle of eSET + one cycle of STP + one cycle of DET, and three DET cycles have an ICER of 26 729 compared with three cycles STP.
CONCLUSIONS: Our study shows that in patients qualifying for IVF treatment, combining several transfer policies was not cost-effective. A choice has to be made between three cycles of eSET, STP or DET. It depends, however, on society's willingness to pay which strategy is to be preferred from a cost-effectiveness point of view.
Key words: Markov model/cost-effectiveness/single embryo transfer/IVF
Submitted on March 25, 2008; resubmitted on January 6, 2009; accepted on January 20, 2009.