RESEARCH – March 2014

Effectiveness and costs of in vitro fertilization in Estonia

Authors: Telvi Tonsiver, Aivar Ehrenberg, Inge Ringmets, Kristiina Lepik, Kadre Saare, Raul-Allan Kiivet

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Objectives. To describe the effectiveness and costs of in vitrofertilization (IVF) in Estonia. This paper is a product from a health technology assessment report, which is available in full detail (in the Estonian language) on the University of Tartu Public Health Library website http://www.rahvatervis.

Methods. Systematic literature reviews were carried out for evidence of effectiveness and cost-effectiveness from the PubMed Database and the Cochrane Database of Systematic Reviews. The Estonian IVF data was analysed based on the records obtained from the Estonian Health Insurance Fund and the Estonian Medical Birth Registry. Data analysis included 4445 women who had 7933 IVF cycles during 2005–2011.

Results. Cumulative pregnancy rate after IVF in Estonia was 41% and delivery rate was 29%. Average delivery rate in the age group under 30 years was 34%, in the age group 31 – 35 years 30% and in the age group over 36 years 19%. Average delivery rate was 30% in the first IVF cycle, 28% in the second cycle and 26% in the 3+ (third and following) cycles. Delivery rate was not significantly different for the agonist and the antagonist cycles. Total costs related to the 7933 IVF cycles during 2005–2011 were 23.4 million euro, which included costs for the IVF procedures; stimulation medications; and costs for the antenatal phase, delivery phase and neonatal phase (up to three months after birth).Costs related to the IVF procedures were 8.8 million euro (38%) and for the medications 6.5 million euros (28%). Costs related to neonatal care were 3.4 million euro (15%). Mean cost per one IVF child was 8409 euro.

Cost per child was significantly higher in the case of preterm births, which is due to hospital care costs. Costs related to preterm singleton births were 5985 euro and costs related to term singleton births were 1072 euro. Of the preterm births 60% were multiple births and of the term births 13% were multiple births. Cost per delivery was 3449 euro in the first cycle and 18 568 in the eighth cycle.

Conclusions. According to literature data and Estonian data analysis, the effectiveness of IVF decreases with age and with rank of the cycle. The effectiveness does not differ for the agonist and the antagonist cycles but the incidence of adverse events is higher for the agonist cycles. Total cost related to the child is five times higher in the case of preterm births, which is due to higher hospital care costs. Cost per delivery increases by 2000 euro with every next cycle needed to achieve birth.