Page 128 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Chapter 6
IVF cycles
Cryo- preservations**
Cryopreservations add to success rates per treatment cycle, as each placement of a cryopreserved embryo is considered part of a previous treatment cycle. Increases in the use of cryopreservation will therefore increase the success rates and the total number of pregnancies. It is also cost effective: at current tariffs, an investment of €10.000 is required to obtain a 10-week pregnancy for IVF and ICSI, while this is under €3.000 for cryopreservation 9. Therefore, extended use of cryopreservation is expected to improve ART outcomes at lower costs. However, due to much lower reimbursements, higher intensity of
 Treatments 10-week Success DRG tariff Cost per Total 2016 (2010)                                     pregnancy       expenses
 Table 6.1: Descriptive statistics on prices, quality and volumes of ART in the Netherlands in 2016 (2010)
   pregnancies 2016 (2010)
rate* 2016
2016
(2010) 2016
     (million
 (2010) euro) 2016
1,240 (1,683) 19% €1,959           (2010)
6,486 (8,750)           (20%) (€1,712)   €10,400         12.7 (16.4)
23% €2,225 (23%) (€2,172)
 ICSI cycles
   6,972 (7,843)
1,627 (1,846)
€10,062
15.5 (19.5)
12,116         1,914 (1,055) 15% €444                   €2,931                 5.4 (2.2) (6,729)                                     (16%)                 (€305)
   36% (27%)
 Total
   4,781 (4,584)
33.6 (38.2)
* Each treatment cycle consists of placement of an embryo through either IVF or ICSI plus one or more embryo transfers through cryopreservation. The total mean success rate is therefore higher than individual IVF ICSI success rates. **All cryopreservations are part of either an IVF cycle or an ICSI cycle and add to the success rate of the treatment cycle. Source: (Vektis, 2017) and NVOG (2010-2016)
      cryopreservation also
reimbursements dropped from 38 million in 2010 to 34 million in 2016, which can largely be explained by increased success rates and uptake of cryopreservation.
reduces per
patient reimbursements for
clinics. Total
For individual clinics, higher success rates reduce the number of treatments and thus reimbursements per patient. Thus, a financial disincentive for quality improvements exists. On the other hand, in a competitive environment improved success rates could attract new patients and increase total treatment volume. To attract new patients, two mechanisms coexist: patient choice and selective contracting of health insurers (Howard, 2006). Preconditions for patient choice appear excellent: ART is an elective treatment, outcomes in terms of success rates are highly valued by patients (van Empel et al., 2011) and the success rates of clinics are known (Kremer et al., 2008). Due to the favorable preconditions for patient choice in AR, it can be considered a best case study. Patient choice for quality has been demonstrated in a number of studies (Cooper et al., 2011; Howard, 2006). Other research in the Dutch context has previously found patient responsiveness to
9 Cost-effectiveness is expressed as the tariff divided by the success rate. E.g. at 20% success rate of IVF, one in five couples obtain a 10-week preganancy at €2,000; resulting in a cost per pregnancy of €10.000. Note that a treatment cycle can include IVF/ICSI and cryopreservation, while the cost effectiveness is calculated separately.
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