Cost of Transferring One Through Five Embryos Per In Vitro Fertilization Cycle From Various Payor Perspectives

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Abstract
OBJECTIVE: We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer. METHODS: Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models stratified by maternal age subgroup. We modeled both total costs, cost-effectiveness (cost per live birth), and clinical outcomes: multiple births, preterm deliveries, and cerebral palsy. RESULTS: From a societal and insurer perspective, it was least expensive to transfer one embryo. For women aged younger than 35 years, it cost society 80% more to transfer five rather than one embryo at a time (total cost $39,212 compared with $21,661). For women aged older than 42 years, it cost 13% more ($29,102 compared with $25,723). From a parental perspective, it was least expensive to transfer between two and five embryos, depending on maternal age. One-embryo transfers markedly improved clinical outcomes. For example, two compared with one-embryo transfers for women aged younger than 35 years reduced preterm birth and cerebral palsy rates by 55% and 41%, respectively. Univariable sensitivity analysis and Monte Carlo simulation showed our results to be robust. CONCLUSION: Transferring one embryo per cycle is the least expensive strategy from a societal perspective, especially for younger women, yet it is the most expensive option from a parental perspective. To reduce in vitro fertilization–associated multiple birth rates, public policy must address these disparate financial incentives.