Cost-effectiveness of freeze-all policy - A retrospective study based upon the outcome of cumulative live births

Jui-Chun Chang; Yu-Chiao Yi; Pao-Sheng Shen; Hwa-Fen Guu; Ya-Fang Chen; Hsiao-Fan Kung; Li-Yu Chen; Ming-Jer Chen

doi:10.1016/j.tjog.2020.11.019

Cost-effectiveness of freeze-all policy - A retrospective study based upon the outcome of cumulative live births

Taiwan J Obstet Gynecol. 2021 Jan;60(1):125-131. doi: 10.1016/j.tjog.2020.11.019.

Authors

Jui-Chun Chang¹, Yu-Chiao Yi², Pao-Sheng Shen³, Hwa-Fen Guu¹, Ya-Fang Chen¹, Hsiao-Fan Kung¹, Li-Yu Chen¹, Ming-Jer Chen⁴

Affiliations

¹ Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
² Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan, ROC.
³ Department of Statistics, Tunghai University, Taichung, Taiwan, ROC.
⁴ Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: mingjerchen@gmail.com.

PMID: 33494984
DOI: 10.1016/j.tjog.2020.11.019

Abstract

Object: We have previously reported that cumulative live birth rates (CLBRs) are higher in the freeze-all group compared with controls (64.3% vs. 45.8%, p = 0.001). Here, we aim to determine if the freeze-all policy is more cost-effective than fresh embryo transfer followed by frozen-thawed embryo transfer (FET).

Materials and methods: The analysis consisted of 704 ART (Assisted reproductive technology) cycles, which included in IVF (In vitro fertilisation) and ICSI (Intra Cytoplasmic Sperm Injection) cycles performed in Taichung Veterans General Hospital, Taiwan between January 2012 and June 2014. The freeze-all group involved 84 patients and the fresh Group 625 patients. Patients were followed up until all embryos obtained from a single controlled ovarian hyper-stimulation cycle were used up, or a live birth had been achieved. The total cost related to treatment of each patient was recorded. The incremental cost-effectiveness ratio (ICER) was based on the incremental cost per couple and the incremental live birth rate of the freeze-all strategy compared with the fresh ET strategy. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were performed.

Results: The total treatment cost per patient was significantly higher for the freeze-all group than in the fresh group (USD 3419.93 ± 638.13 vs. $2920.59 ± 711.08 p < 0.001). However, the total treatment cost per live birth in the freeze-all group was US $5319.89, vs. US $6382.42 in the fresh group. CEAC show that the freeze-all policy was a cost-effective treatment at a threshold of US $2703.57 for one additional live birth. Considering the Willingness-to-pay threshold per live birth, the probability was 60.1% at the threshold of US $2896.5, with the freeze-all group being more cost-effective than the fresh-ET group; or 90.1% at the threshold of $4183.8.

Conclusion: The freeze-all policy is a cost-effective treatment, as long as the additional cost of US $2703.57 per additional live birth is financially acceptable for the subjects.

Keywords: Cost-effectiveness; Cumulative live birth rates; Embryo cryopreservation; Freeze-all; Fresh embryo transfer.

Publication types

Evaluation Study

MeSH terms

Adult
Cost-Benefit Analysis
Cryopreservation / economics*
Embryo Transfer / economics*
Embryo Transfer / methods
Female
Fertilization in Vitro / economics
Fertilization in Vitro / methods
Humans
Infant, Newborn
Live Birth / economics*
Policy*
Pregnancy
Reproductive Techniques, Assisted / economics*
Retrospective Studies
Sperm Injections, Intracytoplasmic / economics
Sperm Injections, Intracytoplasmic / methods
Taiwan