The role of financial cost in patient selection of elective single embryo transfer (ESET) vs. double blastocyst embryo transfer (DBT)

Abstract

OBJECTIVE: The aim of this study is to determine the influence of cost on consumer choice of elective single or double blastocyst embryo transfer in an in vitro fertilization (IVF) program. eSET is increasingly significant in IVF treatment as a means to decrease the risk of multiple pregnancy, including twins, while maintaining high pregnancy rates. Understanding the various factors that may influence a patient's choice of eSET, including financial as discussed here, is important.DESIGN: Retrospective study.MATERIALS AND METHODS: Records of all autologous IVF cycles with blastocyst eSET or DBT during 2006-2007 were reviewed with corresponding financial data. Patients were classified as having insurance coverage, self-pay per cycle (SPPC), or participating in a “Shared Risk” (SR) plan allowing patients to pay a fixed fee for up to 6 IVF cycles to achieve a live birth, with a 100% refund if not successful. Proportions of eSET use were compared between groups by χ2. Among patients with partial or no insurance and not participating in SR, the choice of eSET versus DBT was related to out-of-pocket expenses by logistic regression.Table 1eSET use among all eSET and DBT cycles according to treatment financingSPPCSRInsuranceTransfers2315201082eSET (%)37(16)124 (23.8)268 (24.8)P-value vs SPPC-0.0140.003 Open table in a new tab CONCLUSIONS: Our results indicate that in patients with the choice of eSET vs. DBT, out-of-pocket cost and financial risk to the patient are significantly correlated with the selection of eSET. Patients using the Shared Risk program or with insurance coverage of IVF services were significantly more likely to choose eSET than patients without insurance and not participating in Shared Risk. Moreover, the greater the out-of-pocket expense for the patient, the less likely the patient would choose eSET. OBJECTIVE: The aim of this study is to determine the influence of cost on consumer choice of elective single or double blastocyst embryo transfer in an in vitro fertilization (IVF) program. eSET is increasingly significant in IVF treatment as a means to decrease the risk of multiple pregnancy, including twins, while maintaining high pregnancy rates. Understanding the various factors that may influence a patient's choice of eSET, including financial as discussed here, is important. DESIGN: Retrospective study. MATERIALS AND METHODS: Records of all autologous IVF cycles with blastocyst eSET or DBT during 2006-2007 were reviewed with corresponding financial data. Patients were classified as having insurance coverage, self-pay per cycle (SPPC), or participating in a “Shared Risk” (SR) plan allowing patients to pay a fixed fee for up to 6 IVF cycles to achieve a live birth, with a 100% refund if not successful. Proportions of eSET use were compared between groups by χ2. Among patients with partial or no insurance and not participating in SR, the choice of eSET versus DBT was related to out-of-pocket expenses by logistic regression. CONCLUSIONS: Our results indicate that in patients with the choice of eSET vs. DBT, out-of-pocket cost and financial risk to the patient are significantly correlated with the selection of eSET. Patients using the Shared Risk program or with insurance coverage of IVF services were significantly more likely to choose eSET than patients without insurance and not participating in Shared Risk. Moreover, the greater the out-of-pocket expense for the patient, the less likely the patient would choose eSET.