Page 127 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Do quality improvements in assisted reproduction technology increase patient numbers in a
Governments and health insurers aim to increase the (experienced) quality of care and the population health while containing costs, the so-called triple aim (Berwick et al., 2008; Laurant, 2015). Quality improvements are propagated often as a means to reduce costs. Assisted reproduction technology (ART) treatment is a good case study for this: higher success rates lower the number of attempts and therefore lower costs and –presumably- increase patient satisfaction. ART is an alternative when natural pregnancy fails. Treatment cycles start by ovarian hormonal stimulation, after which one or more eggs are retrieved. Eggs are then fertilized in vitro (IVF) or a sperm cell is injected directly into the egg (ICSI). In about 90% of cycles, one or two fertilized eggs are placed in the uterus. Additional fertilized eggs from the same cycle can be frozen in (cryopreservation), thawed, and placed in the uterus after a first attempt failed. This reduces the burden of starting a full new treatment cycle.
6.1 Introduction
In the Netherlands, three treatment cycles are reimbursed as part of the mandatory benefit package. That is, if certain preconditions (age and BMI) are fulfilled. Tariffs are set by the Dutch Healthcare Authority (table 6.1), while volumes are freely negotiable. Success rates are defined by the percentage of 10-week pregnancies over the total number of treatment cycles (Kremer et al., 2008; Smeenk, 2015). In 2016, 13,458 treatment cycles were started, of which 6,486 involved IVF and 6,972 involved ICSI. An additional 12,116 embryo’s were placed after cryopreservation. Of the 13,458 cycles, 4,781 10-week pregnancies were obtained, a success rate of 36 percent (table 6.1).
Total success rates per started treatment cycle have increased drastically, from under 20 percent in 1997 to 27 percent in 2010 to 36 percent in 2016. Compared to other European countries success rates are higher only in Sweden and Finland (Kupka et al., 2016; Kupka et al., 2014). One possibility to boost success rates is to place multiple embryos at the same time. This increases the number of twins and triplets, which is a risk factor for complications. Multiplets are for that reason regarded as an undesirable outcome. However, over the past years the percentage of multiplets dropped spectacularly in the Netherlands, from 23 percent of 10-week pregnancies in 2003 to 3.8 percent in 2016. Therefore, increases in the success rate increase did not come at the cost of increased risk of complications.
managed competition setting?
Chapter 6
Do quality improvements in assisted reproduction technology increase patient numbers in a managed competition setting?
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