Home monitoring of ovarian stimulation: an important step towards more patient-centred IVF

Patient-level cost analysis of subfertility pathways in the Dutch healthcare system

BACKGROUND

Health economic evaluations require cost data as a key input, and reimbursement policies and systems should incentivize valuable care. Subfertility is a growing global phenomenon, and Dutch per-treatment DRGs alone do not support value-based decision-making because they don't reflect patient-level variation or the impact of technologies on costs across entire patient pathways.

METHODS

We present a real-world micro-costing analysis of subfertility patient pathways (n = 4.190) using time-driven activity-based costing (TDABC) and process mining in the Dutch healthcare system, and built a scalable and granular costing model.

RESULTS

We find that pathways (13.203 treatments, 4.190 patients, 10 years) from referral to pregnancy and birth vary greatly in costs (mean €6.329, maximum €36.976) and duration (mean 25,5 months, maximum 8,59 years), with structural variation within treatments (and DRGs) of up to 65%. Patient-level variation is highest in laboratory phases, and causally related to patients' cycle volume, type, and treatment methods. Large IVF or IVF-ICSI cycles are most common, and most valuable to patients and the healthcare system, but exceed their DRGs significantly (33%). We provide recommendations that reduce costs across patient pathways by €1.3 m in the Netherlands, to support value-based personalized care strategies. These findings are relevant to clinics following European protocols.

CONCLUSIONS

Fertility treatments like IVF feature significant cost variation due to the personalization of treatments, and rapidly evolving laboratory technologies. Incorporating cost granularity at the patient and treatment level (cycle volume, type, method) is critical for decision-making, economic analyses, and policy as both subfertility rates and treatment demand are rising.

The impacts of telemedicine on assisted reproduction: a systematic review and meta-analysis

Telemedicine is being applied in assisted reproduction technology (ART) to provide remote consultations, monitoring and support for patients. This study aimed to evaluate the potential advantages of telemedicine in ART treatment in the form of virtual consultations. Studies in which patients were using telemedicine during ART treatment were identified from four scientific databases (PudMed, EMBASE, Scopus, Web of Science). The success of fertility treatments was compared between telemedicine and in-office care, and patient satisfaction with ART through telemedicine was assessed. Eleven studies, comprising 4697 patients, were identified. Quality assessment (Joanna Briggs Institute Critical Appraisal and revised Cochrane risk-of-bias tools) revealed an acceptable risk of bias for both randomized controlled trials and observational studies. Using a fixed-effects model, telemedicine was comparable to in-person care regarding the pregnancy rate achieved (odds ratio 1.02, 95% confidence intervals 0.83-1.26, P = 0.83). A Q-test suggested that all the included studies were homogeneous. Patients who received telemedicine during fertility treatment reported a high level of satisfaction (91%, 95% confidence intervals 80-96%). Egger's test confirmed that no publication bias was found. Telemedicine could serve as a complementary tool during fertility treatment to facilitate patients' satisfaction and overcome some practical problems without compromising treatment outcomes. Future studies should continue exploring the potential applications of telemedicine in assisted reproduction.