Background Although the medical complications associated withmultiple-gestation pregnancies have been well documented, littleis known about the effects of such pregnancies on the use ofhealth care resources and the associated costs. This is an importantissue because of the increasing use of assisted-reproductiontechniques, which commonly result in multiple-gestation pregnancies.
Methods We determined hospital charges and the use of assisted-reproductiontechniques (such as induction of ovulation, in vitro fertilization,and gamete intrafallopian transfer) for 13,206 pregnant women(11,986 with singleton pregnancies, 1135 with twin pregnancies,and 85 with more than two fetuses) who were admitted for deliveryto Brigham and Women's Hospital, Boston, in 1986 through 1991and their 14,033 neonates (11,671 singletons, 2144 twins, and218 resulting from higher-order multiple gestations).
Results After we controlled for variables known to affect hospitalcharges, the predicted total charges to the family in 1991 fora singleton delivery were $9,845, as compared with $37,947 fortwins ($18,974 per baby) and $109,765 for triplets ($36,588per baby). Assisted-reproduction techniques were used in 2 percentof singleton, 35 percent of twin, and 77 percent of higher-ordermultiple-gestation pregnancies; such procedures were approximatelyequally divided between induction of ovulation alone and invitro fertilization or gamete intrafallopian transfer.
Conclusions Multiple-gestation pregnancies, a high proportionof which result from the use of assisted-reproduction techniques,dramatically increase hospital charges. If all the multiplegestations resulting from assisted-reproduction techniques hadbeen singleton pregnancies, the predicted savings to the healthcare delivery system in the study hospital alone would havebeen over $3 million per year. Although assisted reproductionprovides tremendous benefits to families with infertility, theincreased medical risks entailed by multiple-gestation pregnanciesand the associated costs cannot be ignored. We suggest thatmore attention be paid to approaches to infertility that reducethe likelihood of multiple gestation.
Source Information
From the National Center for Infertility Research at Massachusetts General Hospital as part of the National Cooperative Program on Infertility Research of the National Institute on Child Health and Human Development and the Department of Medicine, Massachusetts General Hospital (T.L.C., J.E.H., W.F.C.); Harvard Medical School (T.L.C.); the Department of Health Care Policy, Harvard Medical School (S.L.E., C.L.C.); and the Department of Obstetrics-Gynecology, Brigham and Women's Hospital (M.F.G.) -- all in Boston.
Address reprint requests to Dr. Hall at the Reproductive Endocrine Unit, Massachusetts General Hospital, Bartlett Hall Extension 5, Fruit St., Boston, MA 02114.
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