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Human Reproduction Update Advance Access originally published online on November 10, 2006
Human Reproduction Update 2007 13(1):5-13; doi:10.1093/humupd/dml053
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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

Economic evaluations of single- versus double-embryo transfer in IVF

A.A.A. Fiddelers1,5, J.L. Severens1,2, C.D. Dirksen1, J.C.M. Dumoulin3, J.A. Land4 and J.L.H. Evers2

1 Department of Clinical Epidemiology and Medical Technology Assessment, Research Institute Grow & Development (GROW) and Care and Public Health Research Institute (CAPHRI), 2 Department of Health Organisation, Policy and Economics, Maastricht University, 3 Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, Maastricht and 4 Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands

5 To whom correspondence should be addressed at: Department of Clinical Epidemiology and Medical Technology Assessment, Research Institute Grow & Development (GROW), Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: afi{at}kemta.azm.nl


  Abstract

Multiple pregnancies lead to complications and induce high costs. The most successful way to decrease multiple pregnancies in IVF is to transfer only one embryo, which might reduce the efficacy of treatment. The objective of this review is to determine which embryo-transfer policy is most cost-effective: elective single-embryo transfer (eSET) or double-embryo transfer (DET). Several databases were searched for (cost* or econ*) and (single embryo* or double embryo* or one embryo* or two embryo* or elect* embryo or multip* embryo*). On the basis of five exclusion criteria, titles and abstracts were screened by two individual reviewers. The remaining papers were read for further selection, and data were extracted from the selected studies. A total of 496 titles were identified through the searches and resulted in the selection of one observational study and three randomized studies. Study characteristics, total costs and probability of live births were extracted. Besides this, cost-effectiveness and incremental cost-effectiveness were derived. It can be concluded that DET is the most expensive strategy. DET is also most effective if performed in one fresh cycle. eSET is only preferred from a cost-effectiveness point of view when performed in good prognosis patients and when frozen/thawed cycles are included. If frozen/thawed cycles are excluded, the choice between eSET and DET depends on how much society is willing to pay for one extra successful pregnancy.

Key words: systematic review / cost-effectiveness / single embryo transfer


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