Document Detail

The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence.
MedLine Citation:
PMID:  8015572     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although the medical complications associated with multiple-gestation pregnancies have been well documented, little is known about the effects of such pregnancies on the use of health care resources and the associated costs. This is an important issue because of the increasing use of assisted-reproduction techniques, which commonly result in multiple-gestation pregnancies. METHODS: We determined hospital charges and the use of assisted-reproduction techniques (such as induction of ovulation, in vitro fertilization, and gamete intrafallopian transfer) for 13,206 pregnant women (11,986 with singleton pregnancies, 1135 with twin pregnancies, and 85 with more than two fetuses) who were admitted for delivery to Brigham and Women's Hospital, Boston, in 1986 through 1991 and their 14,033 neonates (11,671 singletons, 2144 twins, and 218 resulting from higher-order multiple gestations). RESULTS: After we controlled for variables known to affect hospital charges, the predicted total charges to the family in 1991 for a singleton delivery were $9,845, as compared with $37,947 for twins ($18,974 per baby) and $109,765 for triplets ($36,588 per baby). Assisted-reproduction techniques were used in 2 percent of singleton, 35 percent of twin, and 77 percent of higher-order multiple-gestation pregnancies; such procedures were approximately equally divided between induction of ovulation alone and in vitro fertilization or gamete intrafallopian transfer. CONCLUSIONS: Multiple-gestation pregnancies, a high proportion of which result from the use of assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques had been singleton pregnancies, the predicted savings to the health care delivery system in the study hospital alone would have been over $3 million per year. Although assisted reproduction provides tremendous benefits to families with infertility, the increased medical risks entailed by multiple-gestation pregnancies and the associated costs cannot be ignored. We suggest that more attention be paid to approaches to infertility that reduce the likelihood of multiple gestation.
T L Callahan; J E Hall; S L Ettner; C L Christiansen; M F Greene; W F Crowley
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  331     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1994 Jul 
Date Detail:
Created Date:  1994-07-28     Completed Date:  1994-07-28     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  244-9     Citation Subset:  AIM; IM    
National Center for Infertility Research, Massachusetts General Hospital, Boston 02114.
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MeSH Terms
Hospital Charges*
Infant, Newborn
Infertility, Female / economics*,  therapy
Middle Aged
Pregnancy Outcome
Pregnancy, Multiple*
Reproductive Techniques* / economics,  statistics & numerical data
Grant Support
Comment In:
N Engl J Med. 1994 Jul 28;331(4):270-1   [PMID:  8015577 ]

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