The economic impact of singleton, twin and multiple gestation pregnancies in Alberta

Presenter: Charles Yan, Institute of Health Economics

Abstract

Background: The increasing rate of multiple gestation pregnancies, which are associated with greater health resource use, has been attributed to the broad availability and use of assistive reproductive technologies (ARTs). The advocate of publicly funding ARTs argues that, if publicly funded, the government could consider mandating the number of embryos transferred per IVF cycle so as to contain the health care cost.

Objective: The study was to investigate the association between multiple gestations and low birth weight (LBW) infants and to explore the impact on health resource utilization and costs.

Methodology: The population cohort comprised mothers and infants born between April 1, 2004 and March 31, 2005 in Alberta, Canada. The study considered the cost and resource utilization from birth to 1 year for infants and from pregnancy to 3 months post partum for mothers. Information related to hospital utilization costs was collected from Alberta hospital inpatient database, while that related to physician services from the Alberta Health Care Insurance Plan database. The logistic regression was employed to determine the likelihood that twins and higher order multiples (HOM) was born LBW, compared with singletons. A series of linear regressions were used to estimate the impact of multiple births and LBW on resource utilization and costs. Due to lack of additional data, this study assumed that 35% of twins and 77% of HOMs were attributable to ARTs, based on a review of literature. One-way sensitivity analysis was conducted to project costs potentially attributable to ARTs for a range of possible proportions of infants attributable to ART procedures.

Results: A cohort of 36,158 mothers and 36,767 infants were included in the study. Results of the logistic regression analysis indicated that, compared to singletons, twins and HOM were 43.8% and 90% more likely to be born LBW respectively, while HOM were 46.2% more likely to be born LBW in comparison with twins. The mean total cost of LBW twins and LBW HOM were respectively, 5.88 ($14,253 vs. $2,425) and eight times ($19,435 vs. $2,425) greater than that of NBW singletons. The cost burden on health services associated with ARTs twins and HOM was estimated at $5,778,141 with a potential cost savings of $3,562,829 with a change in policy.

Conclusion: This study suggested that multiple births were associated with higher likelihood of being born LBW and consequently resulted in more resource utilization. Further studies that incorporate the cost of providing ARTs and the cost of short and long term health complications are necessary in order to address the impact of ARTs related policies.