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1. Conceiving Naturally After IVF: the effect of assisted reproduction on obstetric interventions and child health at birth

Author

Martinenghi, Fabio I., Zhang, Xian, Rombauts, Luk, and Chambers, Georgina M.

Subjects
Economics - General Economics
Abstract

A growing share of the world's population is being born via assisted reproductive technology (ART), including in-vitro fertilisation (IVF). However, two concerns persist. First, ART pregnancies correlate with predictors of poor outcomes at birth--and it is unclear whether this relationship is causal. Second, the emotional and financial costs associated with ART-use might exacerbate defensive medical behaviour, where physicians intervene more than necessary to reduce the risk of adverse medical outcomes and litigation. We address the challenge of identifying the pure effect of ART-use on both maternal and infant outcomes at birth by leveraging exogenous variation in the success of ART cycles. We compare the obstetric outcomes for ART-conceived births with those of spontaneously-conceived births after a failed ART treatment. Moreover, we flexibly adjust for key confounders using double machine learning. We do this using clinical registry ART data and administrative maternal and infant data from New South Wales (NSW) between 2009-2017. We find that ART slightly decreases the risk of obstetric interventions, lowering the risk of a caesarean section and increasing the rate of spontaneous labour (+3.5 p.p.). Moreover, we find that ART has a statistically and clinically insignificant effect on infant health outcomes. Keywords: Fertility, Assisted reproduction, IVF, Caesarean Section, Obstetric, Infertility. JEL classification: I10, I12, I19.

Published
2024

6. Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study

Author

Abou-Setta, Ahmed M., Aguilera, Juan J., AlAhwany, Hisham, Atanda, Oluseyi O.A., Balkenende, Eva M.E., Barnhart, Kurt T., Beebeejaun, Yusuf, Black, Megan, Chambers, Georgina M., Chughtai, Abrar A., Crosby, Javier A., Cuevas-Sáiz, Irene, Curtis, Cate, D'Angelo, Arianna, Dubois, Danielle D., Duckitt, Kirsten, Encinas, Carlos, Gerval, Marie-Odile, Giang, Nhu H., Gibreel, Ahmed, Gingel, Lynda J., Glanville, Elizabeth J., Glujovsky, Demian, Granne, Ingrid, Griesinger, Georg, Gupta Repromed, Devashana, Hamzehgardeshi, Zeinab, Hirsch, Martin, Horton, Marcos, Jain, Shikha, Jansa Perez, Marta, Jones, Claire A., Kamath, Mohan S., Knijnenburg, José, Kostova, Elena, La Marca, Antonio, Khac Le, Tien, Leader, Arthur, Leeviers, Brigitte, Li Chinese, Jian, Loto, Olabisi M., Marks, Karen L., Martinez-Vazquez, Rodrigo M., McTavish, Alison R., Mills, David J., Nair, Raju R., Thi Phuong Nguyen, Dung, Otter, Anne-Sophie, Pacey, Allan A., Rautakallio-Hokkanen, Satu, Sadler, Lynn C., Sagle, Peggy, Schwarze, Juan-Enrique, Shapiro, Heather M., Simpson, Joe L., Siristatidis, Charalampos S., Sood, Akanksha, Strawbridge, Catherine, Torrance, Helen L., Tu Tran, Cam, Votteler, Emma L., Wang, Chi Chiu, Watson, Andrew, Yossry, Menem, Duffy, J.M.N., Bhattacharya, S., Bofill, M., Collura, B., Curtis, C., Evers, J.L.H., Giudice, L.C., Farquharson, R.G., Franik, S., Hickey, M., Hull, M.L., Jordan, V., Khalaf, Y., Legro, R.S., Lensen, S., Mavrelos, D., Mol, B.W., Niederberger, C., Ng, E.H.Y., Puscasiu, L., Repping, S., Sarris, I., Showell, M., Strandell, A., Vail, A., van Wely, M., Vercoe, M., Vuong, N.L., Wang, A.Y., Wang, R., Wilkinson, J., Youssef, M.A., and Farquhar, C.M.

Published
2021
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7. Developing a core outcome set for future infertility research: an international consensus development study

Author

Abou-Setta, Ahmed M., Aguilera, Juan J., Atanda, Oluseyi O.A., Balkenende, Eva M.E., Barnhart, Kurt T., Beebeejaun, Yusuf, Bhattacharya, Sohinee, Black, Megan, Bofill, Magdalena, Chambers, Georgina M., Chughtai, Abrar A., Crosby, Javier A., Cuevas-Sáiz, Irene, D'Angelo, Arianna, Dubois, Danielle D., Duckitt, Kirsten, Encinas, Carlos, Fincham, Anita, Gerval, Marie-Odile, Giang, Nhu H., Gibreel, Ahmed, Gingel, Lynda J., Glanville, Elizabeth J., Glujovsky, Demian, Granne, Ingrid, Griesinger, Georg, Gupta, Devashana, Hamzehgardeshi, Zeinab, Hickey, Martha, Hirsch, Martin, Horton, Marcos, Hull, M. Louise, Jain, Shikha, Jansa Perez, Marta, Jones, Claire A., Jordan, Vanessa, Kamath, Mohan S., Kostova, Elena, La Marca, Antonio, Khac Le, Tien, Leader, Arthur, Li, Jian, Loto, Olabisi M., Marks, Karen L., McTavish, Alison R., Mills, David J., Nair, Raju R., Thi Phuong Nguyen, Dung, Pacey, Allan A., Sadler, Lynn C., Sagle, Peggy, Schwarze, Juan-Enrique, Shapiro, Heather M., Showell, Marian, Siristatidis, Charalampos S., Sood, Akanksha, Tu Tran, Cam, Votteler, Emma L., Wang, Chi Chiu, Watson, Andrew, Yossry, Menem, Duffy, J.M.N., AlAhwany, H., Bhattacharya, S., Collura, B., Curtis, C., Evers, J.L.H., Farquharson, R.G., Franik, S., Giudice, L.C., Khalaf, Y., Knijnenburg, J.M.L., Leeners, B., Legro, R.S., Lensen, S., Vazquez-Niebla, J.C., Mavrelos, D., Mol, B.W.J., Niederberger, C., Ng, E.H.Y., Otter, A.S., Puscasiu, L., Rautakallio-Hokkanen, S., Repping, S., Sarris, I., Simpson, J.L., Strandell, A., Strawbridge, C., Torrance, H.L., Vail, A., van Wely, M., Vercoe, M.A., Vuong, N.L., Wang, A.Y., Wang, R., Wilkinson, J., Youssef, M.A., and Farquhar, C.M.

Published
2021
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9. Scale-up of Direct-Acting Antiviral Treatment in Prisons Is Both Cost-effective and Key to Hepatitis C Virus Elimination.

Author

Shih, Sophy T F, Stone, Jack, Martin, Natasha K, Hajarizadeh, Behzad, Cunningham, Evan B, Kwon, Jisoo A, McGrath, Colette, Grant, Luke, Grebely, Jason, Dore, Gregory J, Lloyd, Andrew R, Vickerman, Peter, and Chambers, Georgina M

Subjects
HEPATITIS C virus, CLINICAL trial registries, DRUG prices, PRISONS, HEPATITIS C
Abstract

Background The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study demonstrated that scaling up of direct-acting antiviral (DAA) treatment reduced hepatitis C virus (HCV) transmission. We evaluated the cost-effectiveness of scaling up HCV treatment in statewide prison services incorporating long-term outcomes across custodial and community settings. Methods A dynamic model of incarceration and HCV transmission among people who inject drugs (PWID) in New South Wales, Australia, was extended to include former PWID and those with long-term HCV progression. Using Australian costing data, we estimated the cost-effectiveness of scaling up HCV treatment in prisons by 44% (as achieved by the SToP-C study) for 10 years (2021–2030) before reducing to baseline levels, compared to a status quo scenario. The mean incremental cost-effectiveness ratio (ICER) was estimated by comparing the differences in costs and quality-adjusted life-years (QALYs) between the scale-up and status quo scenarios over 40 years (2021–2060) discounted at 5% per annum. Univariate and probabilistic sensitivity analyses were performed. Results Scaling up HCV treatment in the statewide prison service is projected to be cost-effective with a mean ICER of A$12 968/QALY gained. The base-case scenario gains 275 QALYs over 40 years at a net incremental cost of A$3.6 million. Excluding DAA pharmaceutical costs, the mean ICER is reduced to A$6 054/QALY. At the willingness-to-pay threshold of A$50 000/QALY, 100% of simulations are cost-effective at various discount rates, time horizons, and changes of treatment levels in prison and community. Conclusions Scaling up HCV testing and treatment in prisons is highly cost-effective and should be considered a priority in the national elimination strategy. Clinical Trials Registration NCT02064049. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Residential proximity to a fertility clinic is independently associated with likelihood of women having ART and IUI treatment

Author

Lazzari, Ester, Baffour, Bernard, and Chambers, Georgina M

Subjects
Fertility Clinics, Reproductive Techniques, Assisted, social inequalities, Rehabilitation, utilization, Australia, Obstetrics and Gynecology, medically assisted fertility treatments, geographic accessibility, Reproductive Medicine, assisted reproductive technology, Infertility, Humans, Female, Insemination, Artificial, intrauterine insemination
Abstract

STUDY QUESTION Is geographic proximity to a fertility clinic associated with the likelihood of women of reproductive age undertaking different forms of medically assisted fertility treatment? SUMMARY ANSWER After adjusting for socioeconomic status (SES) and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI treatment than those who lived further than 60 km away. WHAT IS KNOWN ALREADY In most countries, patients living outside of metropolitan areas are more likely to be more socio-economically disadvantaged and to have less equitable access to healthcare. However, how a woman’s residential proximity to fertility clinics predicts utilization of high-cost/high-technology treatment (ART) and low-cost/low-technology treatment (IUI) is limited, and whether socio-economic disadvantage explains much of the hypothesized lower utilization is unknown. Australia’s universal insurance scheme provides supportive reimbursement for almost all ART and IUI treatment regardless of age or number of cycles, providing a unique setting to investigate disparities in access to infertility treatment. STUDY DESIGN, SIZE, DURATION National population-based observation study of ART and IUI treatment utilization by women across socio-economic gradients and Australian residential locations between August 2015 and December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Universal insurance claims information on female patients who underwent ART or IUI were provided by Services Australia, comprising 67 670 female patients who accessed 162 795 ART treatments, and 10 211 female patients who accessed 19 615 IUI treatments over a 29-month period. Incidence rates by SES and proximity to fertility clinics were calculated to describe the number of women undergoing at least one ART or IUI treatment cycle per 1000 women of reproductive age (25–44). Treatment frequencies were calculated to describe the average number of ART or IUI treatment cycles per woman of reproductive age who had undergone at least one ART or IUI treatment during the study period. Poisson regression analyses were used to estimate the independent effect on accessibility to infertility treatment by geographic proximity (based on small area locations) to the closest fertility clinic after adjusting for SES, childbearing delay, remoteness area, and marital status. MAIN RESULTS AND THE ROLE OF CHANCE On average, 19.1 women per 1000 women of reproductive age underwent at least one fresh or frozen ART cycle, with an average 2.3 ART cycles each, while 3.0 women per 1000 women of reproductive age received at least one IUI cycle, with an average of 1.6 IUI cycles each. After adjusting for SES and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI than those who lived over 60 km away. Regardless of geographic location, there was a steady and independent gradient in access to ART treatment based on increasing SES, with women residing in the most advantaged residential quartile having a 37% higher rate of receiving ART treatment compared to those in the most disadvantaged quartile. The negative effect of social disadvantage on ART use became more pronounced as distance from a fertility clinic grew, indicating that the barriers to access to ART care caused by distance were further compounded by the level of socioeconomic advantage of the women’s residential location. In contrast, socioeconomic status did not modify the likelihood of using IUI over and above the distance from a fertility clinic. In relation to IUI treatment, differences in utilization by SES disappeared after adjusting for geographic proximity to a fertility clinic, childbearing delay, remoteness area, and marital status. LIMITATIONS, REASONS FOR CAUTION Information is aggregated by small geographic areas and it therefore may not reflect individual characteristics. Australia provides partial but comparably supportive reimbursement for both ART and IUI through its universal healthcare system and thus the results may not be fully generalizable to other settings. WIDER IMPLICATIONS OF THE FINDINGS Residential proximity to a fertility clinic is a persistent barrier to accessing ART and IUI treatment, regardless of SES, even in countries characterized by supportive public funding, such as Australia. SES is less of a barrier to accessing IUI than ART, presumably driven by the lower cost and fewer clinic visits required with IUI treatment. Safe and effective fertility treatment should be available to all women regardless of where they live. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Australian National University Research scholarship and by the Higher Degree Research Fee Merit Scholarship. The authors have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

Published
2022

26. Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis

Author

Kwon, Jisoo A., primary, Chambers, Georgina M., additional, Luciani, Fabio, additional, Zhang, Lei, additional, Kinathil, Shamin, additional, Kim, Dennis, additional, Thein, Hla-Hla, additional, Botha, Willings, additional, Thompson, Sandra, additional, Lloyd, Andrew, additional, Yap, Lorraine, additional, Gray, Richard T., additional, and Butler, Tony, additional

Published
2021
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27. Developing a core outcome set for future infertility research: an international consensus development study

Author

Duffy, J.M.N., primary, AlAhwany, H., additional, Bhattacharya, S., additional, Collura, B., additional, Curtis, C., additional, Evers, J.L.H., additional, Farquharson, R.G., additional, Franik, S., additional, Giudice, L.C., additional, Khalaf, Y., additional, Knijnenburg, J.M.L., additional, Leeners, B., additional, Legro, R.S., additional, Lensen, S., additional, Vazquez-Niebla, J.C., additional, Mavrelos, D., additional, Mol, B.W.J., additional, Niederberger, C., additional, Ng, E.H.Y., additional, Otter, A.S., additional, Puscasiu, L., additional, Rautakallio-Hokkanen, S., additional, Repping, S., additional, Sarris, I., additional, Simpson, J.L., additional, Strandell, A., additional, Strawbridge, C., additional, Torrance, H.L., additional, Vail, A., additional, van Wely, M., additional, Vercoe, M.A., additional, Vuong, N.L., additional, Wang, A.Y., additional, Wang, R., additional, Wilkinson, J., additional, Youssef, M.A., additional, Farquhar, C.M., additional, Abou-Setta, Ahmed M., additional, Aguilera, Juan J., additional, Atanda, Oluseyi O.A., additional, Balkenende, Eva M.E., additional, Barnhart, Kurt T., additional, Beebeejaun, Yusuf, additional, Bhattacharya, Sohinee, additional, Black, Megan, additional, Bofill, Magdalena, additional, Chambers, Georgina M., additional, Chughtai, Abrar A., additional, Crosby, Javier A., additional, Cuevas-Sáiz, Irene, additional, D'Angelo, Arianna, additional, Dubois, Danielle D., additional, Duckitt, Kirsten, additional, Encinas, Carlos, additional, Fincham, Anita, additional, Gerval, Marie-Odile, additional, Giang, Nhu H., additional, Gibreel, Ahmed, additional, Gingel, Lynda J., additional, Glanville, Elizabeth J., additional, Glujovsky, Demian, additional, Granne, Ingrid, additional, Griesinger, Georg, additional, Gupta, Devashana, additional, Hamzehgardeshi, Zeinab, additional, Hickey, Martha, additional, Hirsch, Martin, additional, Horton, Marcos, additional, Hull, M. Louise, additional, Jain, Shikha, additional, Jansa Perez, Marta, additional, Jones, Claire A., additional, Jordan, Vanessa, additional, Kamath, Mohan S., additional, Kostova, Elena, additional, La Marca, Antonio, additional, Khac Le, Tien, additional, Leader, Arthur, additional, Li, Jian, additional, Loto, Olabisi M., additional, Marks, Karen L., additional, McTavish, Alison R., additional, Mills, David J., additional, Nair, Raju R., additional, Thi Phuong Nguyen, Dung, additional, Pacey, Allan A., additional, Sadler, Lynn C., additional, Sagle, Peggy, additional, Schwarze, Juan-Enrique, additional, Shapiro, Heather M., additional, Showell, Marian, additional, Siristatidis, Charalampos S., additional, Sood, Akanksha, additional, Tu Tran, Cam, additional, Votteler, Emma L., additional, Wang, Chi Chiu, additional, Watson, Andrew, additional, and Yossry, Menem, additional

Published
2021
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28. Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study

Author

Duffy, J.M.N., primary, Bhattacharya, S., additional, Bofill, M., additional, Collura, B., additional, Curtis, C., additional, Evers, J.L.H., additional, Giudice, L.C., additional, Farquharson, R.G., additional, Franik, S., additional, Hickey, M., additional, Hull, M.L., additional, Jordan, V., additional, Khalaf, Y., additional, Legro, R.S., additional, Lensen, S., additional, Mavrelos, D., additional, Mol, B.W., additional, Niederberger, C., additional, Ng, E.H.Y., additional, Puscasiu, L., additional, Repping, S., additional, Sarris, I., additional, Showell, M., additional, Strandell, A., additional, Vail, A., additional, van Wely, M., additional, Vercoe, M., additional, Vuong, N.L., additional, Wang, A.Y., additional, Wang, R., additional, Wilkinson, J., additional, Youssef, M.A., additional, Farquhar, C.M., additional, Abou-Setta, Ahmed M., additional, Aguilera, Juan J., additional, AlAhwany, Hisham, additional, Atanda, Oluseyi O.A., additional, Balkenende, Eva M.E., additional, Barnhart, Kurt T., additional, Beebeejaun, Yusuf, additional, Black, Megan, additional, Chambers, Georgina M., additional, Chughtai, Abrar A., additional, Crosby, Javier A., additional, Cuevas-Sáiz, Irene, additional, Curtis, Cate, additional, D'Angelo, Arianna, additional, Dubois, Danielle D., additional, Duckitt, Kirsten, additional, Encinas, Carlos, additional, Gerval, Marie-Odile, additional, Giang, Nhu H., additional, Gibreel, Ahmed, additional, Gingel, Lynda J., additional, Glanville, Elizabeth J., additional, Glujovsky, Demian, additional, Granne, Ingrid, additional, Griesinger, Georg, additional, Gupta Repromed, Devashana, additional, Hamzehgardeshi, Zeinab, additional, Hirsch, Martin, additional, Horton, Marcos, additional, Jain, Shikha, additional, Jansa Perez, Marta, additional, Jones, Claire A., additional, Kamath, Mohan S., additional, Knijnenburg, José, additional, Kostova, Elena, additional, La Marca, Antonio, additional, Khac Le, Tien, additional, Leader, Arthur, additional, Leeviers, Brigitte, additional, Li Chinese, Jian, additional, Loto, Olabisi M., additional, Marks, Karen L., additional, Martinez-Vazquez, Rodrigo M., additional, McTavish, Alison R., additional, Mills, David J., additional, Nair, Raju R., additional, Thi Phuong Nguyen, Dung, additional, Otter, Anne-Sophie, additional, Pacey, Allan A., additional, Rautakallio-Hokkanen, Satu, additional, Sadler, Lynn C., additional, Sagle, Peggy, additional, Schwarze, Juan-Enrique, additional, Shapiro, Heather M., additional, Simpson, Joe L., additional, Siristatidis, Charalampos S., additional, Sood, Akanksha, additional, Strawbridge, Catherine, additional, Torrance, Helen L., additional, Tu Tran, Cam, additional, Votteler, Emma L., additional, Wang, Chi Chiu, additional, Watson, Andrew, additional, and Yossry, Menem, additional

Published
2021
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38. A reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government

Author

Chambers Georgina M, Hoang Van, Zhu Rong, and Illingworth Peter J

Subjects
Assisted reproductive technology, In vitro fertilization, Infertility, Policy evaluation, Econometrics, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born. Methods Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid. Results After controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p Conclusions The introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children.

Published
2012
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43. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2012†.

Author

Mouzon, Jacques de, Chambers, Georgina M, Zegers-Hochschild, Fernando, Mansour, Ragaa, Ishihara, Osamu, Banker, Manish, Dyer, Silke, Kupka, Markus, Adamson, G David, and de Mouzon, Jacques

Subjects
*REPRODUCTIVE technology, *HUMAN artificial insemination, *HUMAN reproduction, *EMBRYO transfer, *HUMAN embryology, *BIRTH rate, *FERTILIZATION in vitro
Abstract

Study Question: What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed?Summary Answer: The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing and single embryo transfers (SET), whereas pregnancy and delivery rates (PR, DR) remained stable, and multiple deliveries decreased.What Is Known Already: ART is widely practiced throughout the world, but continues to be characterized by significant disparities in utilization, availability, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report provides a major tool for tracking trends in ART treatment for over 25 years and gives important data to ART professionals, public health authorities, patients and the general public.Study Design, Size, Duration: A retrospective, cross-sectional survey on the utilization, effectiveness and safety of ART procedures performed globally during 2012 was carried out.Participants/materials, Setting, Methods: Sixty-nine countries and 2600 ART clinics submitted data on ART cycles performed during the year 2012, and their pregnancy outcome, through national and regional ART registries. ART cycles and outcomes are described at country, regional and global levels. Aggregate country data were processed and analyzed based on methods developed by ICMART.Main Results and Role Of Chance: A total of 1 149 817 ART cycles were reported for the treatment year 2012. After imputing data for missing values and non-reporting clinics in reporting countries, 1 948 898 cycles (an increase of 18.6% from 2011) resulted in >465 286 babies (+17.9%) in reporting countries. China did not report and is not included in this estimate. The best estimate of global utilization including China is ∼2.8 million cycles and 0.9 million babies. From 2011 to 2012, the number of reported aspirations and FET cycles increased by 6.9% and 16.0%, respectively. The proportion of women aged 40 years or older undergoing non-donor ART increased from 24.0% in 2011 to 25.2% in 2012. ICSI, as a percentage of non-donor aspiration cycles, increased from 66.5% in 2011 to 68.9% in 2012. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycles were 19.8% and 22.1%, respectively. In fresh non-donor cycles, SET increased from 31.4% in 2011 to 33.7% in 2012, while the average number of transferred embryos decreased from 1.91 to 1.88, respectively-but with wide country variation. The rates of twin deliveries following fresh non-donor transfers decreased from 19.6% in 2011 to 18.0% in 2012, and the triplet rate decreased from 0.9% to 0.8%. In FET non-donor cycles, SET was 54.8%, with an average of 1.54 embryos transferred and twin and triplet rates of 11.1% and 0.4%, respectively. The cumulative DR per aspiration increased from 28.0% in 2011 to 28.9% in 2012. The overall perinatal mortality rate per 1000 births was 21.4 following fresh IVF/ICSI and 15.9 per 1000 following FET.Limitations, Reasons For Caution: The data presented depend on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of` world ART activity, with a major missing country, China. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed, including the use of internationally agreed standard definitions (International Glossary of Infertility and Fertility Care).Wider Implications Of the Findings: The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policy makers. With the increasing practice of SET and of freeze all and resulting increased proportion of FET cycles, it is clear that PR and DR per aspiration in fresh cycles do not give an overall accurate estimation of ART efficiency. It is time to use cumulative live birth rate per aspiration, combining the outcomes of FET cycles with the associated fresh cycle from which the embryos were obtained, and to obtain global consensus on this approach.Study Funding/competing Interest(s): The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART gratefully acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Ferring Pharmaceuticals and Abbott (both providing ICMART unrestricted grants unrelated to world reports).Trial Registration Number: NA. [ABSTRACT FROM AUTHOR]

Published
2020
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46. Assessing societal and offender perspectives on the value of offender healthcare: a stated preference research protocol.

Author

Nalukwago Settumba, Stella, Shanahan, Marian, Chambers, Georgina M., Schofield, Peter, and Butler, Tony

Abstract

Introduction The increasing burden that offenders place on justice and health budgets necessitates better methods to determine the benefits of and value society places on offender programmes to guide policy regarding resource allocation. The aim of this paper is to demonstrate how economic methods will be used to determine the strength of preferences and value of violent offender treatment programmes from the perspectives of offenders, their families and the general population. Methods and analysis Two stated preference economic methods, discrete choice experiment (DCE) and contingent valuation (CV), will be used to assess society's and offenders' value of treatment programmes. The mixed methods process involves a literature review and qualitative methods to derive attributes and levels for the DCE and payment card values for the CV. Consensus building approaches of voting, ranking and the Delphi method will be used to further refine the findings from the qualitative phase. Attributes and their levels will be used in a D-efficient Bayesian experimental design to derive choice scenarios for the development of a questionnaire that will also include CV questions. Finally, quantitative surveys to assess societal preferences and value in terms of willingness to pay will be conducted. Ethics and dissemination Ethics approval for this study was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee, Corrective Services New South Wales Ethics Committee and the Aboriginal Health and Medical Research Council ethics committee. The findings will be made available on the Kirby Institute UNSW website, published in peer-reviewed journals and presented at national and international conferences. [ABSTRACT FROM AUTHOR]

Published
2019
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