The first year outcome of twin pregnancies in the Netherlands with a focus on costs; a registry-based study
12 / 2005 - onbekend
The OBJECTIVE of this focussed study is to enable valid cost-effectiveness analysis of infertility treatments, which now are hampered by vital uncertainties considering post natal costs and outcomes of twins.Comparison of treatments like IVF-DET, IVF-SET and IUI with or without stimulation, with the many policy variants dealing with prior success differences and time left to conceive urgently need this information as the higher costs per 12 week pregnancy, has to be offset by lower twin pregnancy rates with the associated higher costs. A recent ZonMw report clearly showed the dependence of cost-effectivness ratios and budget consequences on valid twin cost estimations, even with a one years tome horizon. These one year costs (about 25-50% of life time discounted extra costs) are thought to be highly indicative of total costs.The RESEARCH QUESTION is: what are the registry-data based twin costs and global outcome at one year follow up, comparing fertility/non fertility twins, premature twins vs. similar singletons, accounting for maternal age. The empirical assumption is that these costs are indicative for life time costs. Prices will be based on average tariffs as the study encompassess the Netherlands.Registries as such do not contain this information, but current research has shown the feasibility of anonymous record linkage of all registries in this context, which includes a detailed admission registry. The solution of specific problems of twin data linkage make up the majority of the research project. Samenvatting One of the acknowledged drawbacks of most fertility treatments is the increased risk for twin pregnancies. While survey studies of parents-to-be and twin parents sofar report both groups accept the risk and even may welcome the 2 children given the burdensome treatment, both health outcome and costs of twins represent a substantial disadvantage in medical and economic terms.Current innovation in fertility treatment is focussed on decreasing the risk for twins while keeping the pregnanciy rates about the same. From provisional estimations of the cost-effectiveness of these programmes (like Single Embryo Transfer IVF) as recently published in the ZONMW-report Vruchtbaarheidsstoornissen offered to the Dpt of Health, it appears that the costs of twins, more particular of the twins with adverse outcome (usually very preterm) are a critical factor. Surprisingly, little quantitative information exists on these outcome of twins, where first year clinical costs and medical outcome usually are predictive for life time costs.This study determines first year clinical costs and crude outcome of twins (fertility treatment related vs. not) based on thorough analysis of registry data. Preterms will be compared with similar singleton preterms.The study takes advantage of the current LinKID study under responsibility of 3 medical societies (neonatologists/pediatricians, obstetricians, midwives) which validates the anonymous record of registry data in particular of twins.