November 12, 2013
Having Twins Nearly Five Times As Costly As A Single Delivery
Brett Smith for redOrbit.com - Your Universe Online
Advances in reproductive technologies such as ovulation induction and in vitro fertilization (IVF) have helped many couples to start a family, but these medical advances have also resulted in an increase in multiple birth pregnancies.
A new study in the American Journal of Obstetrics & Gynecology has found US pregnancies that end in the delivery of twins cost about five-fold more than singleton pregnancies, and the delivery of triplets or more cost nearly 20 times as much as singletons.
In the study, researchers used data from the Truven Health MarketScan Commercial Claims and Encounters Database to examine the differences in costs among the different types of pregnancies. The researchers’ study cohort included all women between the ages of 19 and 45 years old who delivered at least one live infant between January 2005 and September 2010 – equaling nearly 440,000 delivery events. Of these, about 97 percent were singletons, about 2.8 percent were twins and 0.13 percent of the pregnancies produced triplets or more.
The research team included medical costs incurred by mothers during the 27 weeks leading up to and about 30 days after the delivery date. They also considered medical costs for infants up until their first birthday.
"By taking a broad approach, we have shown that medical expenses attributable to mothers and infants varied according to birth multiplicity," said study author Dongmu Zhang, a research leader at Merck & Co. "For singleton pregnancy, maternal expenses accounted for about 60 percent of overall cost; whereas for twins or higher-order multiple births, expenses for infant care accounted for about 70 percent and 85 percent of total expenses, respectively."
The adjusted total healthcare cost was around $21,000 per delivery for singletons, $105,000 for twins, and over $400,000 for triplets or more, the study found.
The research team also considered co-existing conditions, which they labeled a systemic condition such as hypertension, cardiovascular disease, diabetes, thyroid disease, anemia and conditions in the reproductive tract. Women with twins or more had considerably more co-existing conditions in each category than women who delivered a single baby. Mothers with twins or triplets or more also had longer hospital visits for delivery and a higher mortality rate.
"On average, combined all-cause healthcare expenses for mothers with twins or higher-order multiple births were about five and 20 times more expensive, respectively, than singleton delivery,” Zhang said. “The greater expenses were likely to have been due to increased maternal morbidities, significantly increased use of cesarean section and longer hospital stay for the deliveries in women with multiple pregnancies, and increased admission and longer stay in NICU for neonates of multiple gestations.
“We also demonstrated increased mortality for both mothers and infants associated with multiple pregnancies, although the absolute rates were small,” he added.
The research team said their study was the first to consider medical expenses for both maternal and infant care associated with IVF-assisted pregnancy. The researchers recommended that IVF strategies should be aimed at minimizing multiple embryo transfer, which would reduce the burden associated with multiple pregnancies.