Direct health services costs of providing assisted reproduction services in older women.

摘要

OBJECTIVE: To assess the total health service costs incurred for each live birth achieved by older women undergoing IVF compared with costs in younger women. DESIGN: Retrospective cross-sectional analysis. SETTING: In vitro fertilization unit and maternity hospital in a tertiary care setting. PATIENT(S): Women who underwent their first cycle of IVF between 1997 and 2006. INTERVENTION(S): Bottom-up costs were calculated for all interventions in the IVF cycle. Early pregnancy and antenatal care costs were obtained from National Health Service reference costs, Information Services Division Scotland, and local departmental costs. MAIN OUTCOME MEASURE(S): Cost per live birth. RESULT(S): The mean cost per live birth (95% confidence interval [CI]) in women undergoing IVF at the age of > or =40 years was pound 40,320 (pound 27,105- pound 65,036), which is >2.5 times higher than those aged 35-39 years (pound 17,096 [pound 15,635- pound 18,937]). The cost per ongoing pregnancy was almost three times in women aged > or =40 (pound 31,642 [pound 21,241- pound 58,979]) compared with women 35-39 years of age (pound 11,300 [pound 10,006- pound 12,938]). CONCLUSION(S): The cost of a live birth after IVF rises significantly at the age of 40 years owing to lower success rates. Most of the extra cost is due to the low success of IVF treatment, but some of it is due to higher rates of early pregnancy loss.