Multiple Birth Pregnancies Can Cost Nearly 20 Times More Than Singleton Pregnancies
Strategies to minimize multiple embryo transfer should be considered, say
researchers in the American Journal of Obstetrics & Gynecology
Philadelphia, PA, November 11, 2013
Multiple pregnancies are a major
public health concern in the United States and the rest of the world due to the
significantly higher health risks for both mothers and infants, as well as the
impact on healthcare costs. Investigators analyzed and compared the cost of
multiple versus single-birth pregnancies and found that pregnancies with
delivery of twins cost about five times more than singletons, and pregnancies
with delivery of triplets or more cost nearly 20 times as much. They call for
strategies to reduce this burden. Their findings are published in the American Journal of Obstetrics &
Gynecology.
Multiple pregnancies are increasing worldwide in parallel with increased use of
reproductive technologies such as ovulation induction and in vitro
fertilization (IVF). According to the Centers for Disease Control and Prevention
(CDC), 3% of all infants born in the United States in 2010 were multiple
deliveries. The twin birth rate was 33 per 1,000 total births, and the rate of
triplets and more was 1.4 per 1,000 births. Experts generally agree that while less
than half (about 40%) of twin births result from assisted reproductive
technologies, this increases to around 80% of births of triplets or more.
The current study documents and compares costs associated with multiple
pregnancies versus singletons in the United States, using the Truven Health
MarketScan Commercial Claims and Encounters Database. The study population
included all women aged 19-45 years who delivered at least one live born infant
between January 2005 and September 2010. Investigators identified 437,924
eligible delivery events during the study period. Of these, about 97% (424,880)
were singletons, 2.85% (12,482) were twins, and 0.13% (562) were triplets or
more.
For mothers, the cost included medical expenses during the 27 weeks before and
up to 30 days after the delivery date. For infants, costs contained all medical
expenses up to their first birthday. This is the first study taking into
account a comprehensive assessment of the incremental cost associated with
multiple pregnancies by estimating all-cause medical expenses over this
timeframe.
"By taking a broad approach, we have shown that medical expenses attributable
to mothers and infants varied according to birth multiplicity," comments lead
investigator Dongmu Zhang,
PhD, Global Health Outcomes, Merck & Co. "For singleton pregnancy, maternal expenses accounted for about
60% of overall cost. whereas for twins or higher-order multiple births,
expenses for infant care accounted
for about 70% and 85% of total expenses, respectively."
The adjusted total all-cause
healthcare cost was around $21,000 per delivery with singletons, $105,000 with
twins, and over $400,000 with triplets or more.
The investigators took into account co-existing conditions, which they
categorized into systemic conditions such as hypertension, cardiovascular
disease, diabetes, edema/renal disease, genitourinary infection, thyroid
disease, and anemia, and conditions in the reproductive tract. Women
with twins or more had significantly higher co-existing conditions in each category
than women who delivered singletons. Mothers with twins or triplets or more also
had longer hospital stays for delivery and higher mortality.
"On average, combined all-cause healthcare expenses for mothers with twins or
higher-order multiple births were about five and 20 times more expensive,
respectively, than singleton delivery. The greater expenses were likely to have
been due to increased maternal morbidities, significantly increased use of
cesarean section and longer hospital stay for the deliveries in women with
multiple pregnancies, and increased admission and longer stay in NICU for
neonates of multiple gestations. We also demonstrated increased mortality for
both mothers and infants associated with multiple pregnancies, although the
absolute rates were small," Dr. Zhang adds.
To the researchers' knowledge,
this is the first study that reports increased medical expenses for both maternal
and infant care associated with IVF-assisted pregnancy.
The researchers comment that for women undergoing IVF, the risk of
multiple pregnancies is due nearly entirely to multiple embryo transfer, and
recommend that strategies aiming at minimizing multiple embryo transfer should
be considered to reduce the burden associated with multiple pregnancies.
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Notes for editors
"Healthcare Expenses Associated with Multiple Pregnancies versus
Singletons in the United States," by Elkin V. Lemos, MD, PhD, Dongmu
Zhang, PhD, Bradley J. Van Voorhis, MD, X. Henry Hu, MD, MPH, PhD (DOI: http://dx.doi.org/10.1016/j.ajog.2013.10.005), American
Journal of Obstetrics & Gynecology, Volume 209, Issue 6 (December 2013),
published by Elsevier.
Full text of the article is
available to credentialed journalists upon request. Contact Eileen Leahy at +1 732
238 3628or ajogmedia@elsevier.com to obtain
a copy. Journalists wishing to schedule interviews with the authors should
contact Dongmu Zhang, PhD, at +1 215 652 6097 or dongmu.zhang@merck.com.
Authors
Elkin V. Lemos, MD, PhD,
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, PA,
USA, and Global Health Outcomes, Merck & Co., Inc., West Point, PA, USA
Dongmu Zhang, PhD, Global Health
Outcomes, Merck & Co., Inc., West Point, PA, USA
Bradley J. Van Voorhis, MD, College
of Medicine, University of Iowa, Iowa City, IA, USA
X. Henry Hu, MD, MPH, PhD, Global
Health Outcomes, Merck & Co., Inc., West Point, PA, USA
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Elsevier
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ajogmedia@elsevier.com