A Time-motion Comparison of Itemized Treatment Costs in First and Second In Vitro Fertilization Attempts: A United Kingdom Fertility Centre Experience.

Dev Kumar,Christopher A Jones,Renju S Raj,Olivia J Carpinello,E Scott Sills,Louis G Keith

doi:10.36469/9855

Abstract

Objective: To assess the difference in cost between initial and second in vitro fertilization (IVF) cycles in the United Kingdom. Methods: This prospective time-motion analysis captured data on average time spent on 31 representative components of the IVF sequence as provided by clinical team members in seven categories. Audits of consumables and observations on personnel costs were made from total of 120 fertility patients undergoing initial or second IVF cycles (n=736) between 1 January 2002 and 31 December 2002 at a UK assisted fertility unit. Results: Patients spent an average of 16.71±4.3 hrs with staff during an initial IVF cycle, resulting in direct personnel costs of £577.05±151.01. When consumables were included, each initial cycle cost the clinic approximately £2246.57±151.01. For second IVF cycles, patients spent significantly less time with staff compared to their first IVF cycle (6.94±2.44 hrs; p<0.05), corresponding to £257.53±90.77 in personnel cost. Conclusions: This is the first economic appraisal of the IVF treatment sequence in the UK using a timemotion analysis model. Our study found that when combined with consumables, total institutional costs for second IVF cycles were significantly reduced when compared to initial cycles (£1813.12±90.77; p<0.05). Aggregating data from all IVF cycles performed within the fertility centre during the study interval, initial cycles were found to be front-loaded, resulting in £252,420 more in institutional costs as compared with subsequent IVF cycles. While these observations were registered in 2003, an inflation adjustment using recent European Commission Eurostat data for healthcare finds the difference between initial and subsequent fresh IVF cycles in present currency to be approximately £579.14 per cycle. Time-motion analysis can identify episodes of care that can be streamlined to improve outcomes and reduce cost.

Highlights

The utilisation of advanced reproductive technologies has increased dramatically in the United Kingdom over the past 20 years
Following registration with the Human Fertilisation & Embryology Authority (HFEA), non-identifiable and anonymous data were tabulated on patient volunteers (n=120 couples) who received fresh, non-donor gamete in vitro fertilisation (IVF) treatment at a university-affiliated fertility centre in the United Kingdom
The results are based on five observations for each of the 34 treatment components that make up initial cycles and five observations for each of the 26 treatment components that make up repeat fresh cycles

Summary

Introduction

The utilisation of advanced reproductive technologies has increased dramatically in the United Kingdom over the past 20 years. A total of 6,650 IVF cycles were performed in 1991, and (except for a brief decline in 1998-1999), this number has steadily increased each subsequent year to 37,600 by 2003. In the late 1990’s, for example, only approximately 15% of the UK couples who qualified for IVF underwent this treatment.[13] While this low utilisation rate may be attributed to stresses associated with IVF or with the decision not to have children, these issues are not unique to UK patients. The impact of high treatment cost and the prospect of relatively low success rates could contribute to the relatively low IVF uptake rate in the United Kingdom. In 1998 for example, only 10.8 IVF cycles per 100,000 population were funded by the NHS, which resulted in most IVF cycles being paid for by patients privately.[14]

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Discussion

Conclusion