A prospective observational study comparing the effect of a new one-stop fertility clinic versus the conventional NHS fertility pathway on NHS costs and patients’ quality of life, and a study on UK and international ART treatment and the relationship with high multiple pregnancies and associated costs.

Thesis

Background: NHS-funded ART cycles are gradually being reduced or completely stopped by several Clinical Commissioning Groups (CCGs) aiming to make savings of between £300,000- £800,000 per year. This has led to a decrease in NHS ART treatment available, which may lead to an increasing number of UK residents seeking treatment overseas. Overseas ART treatment may be associated with a higher rate of multiple pregnancies, associated with higher morbidity for patients, and cost to the NHS. I proposed a study to assess if a One-stop fertility pathway could reduce investigation duration and lead to cost savings that could be used to maintain funding for ART cycles and improve the patients’ Quality of Life (QoL). I also reviewed the High Multiple Pregnancies (HMP) at the John Radcliffe (JR) Hospital in Oxford to assess the impact from ART performed in the UK and overseas.

Methods: A prospective observational study comparing duration, costs and QoL of 191 participants going through the Conventional pathway and 28 participants going through a One-Stop pathway. And a retrospective observational review of 43 (HMP) at the JR over 7 years.

Results: One-stop pathway reduced the average duration by 426.9 days p=0.016 and cost by £435.1 p=<0.001, which could mean total savings £670,415.28 a year per CCG. One-stop participants had a lower average QoL score compared to the Conventional participants, 64.3 (16) vs 72.1 (14.0) p=0.018. Female participants QoL was lower than male, with a FertiQoL score of 67.9 (15.6) vs 75.6(13.2) p = <0.001 and approaching levels of clinical depression. A review of 43 HMPs at the JR between 2010 and 2017 showed that on average HMPs cost £68,222 per pregnancy and £366,695 per year and 53% of the HMPs were conceived by ART.

Conclusions: One-Stop Fertility clinics decrease the duration and cost of fertility investigation, saving as much as £670,415.28 per year for a CCG. These savings could be “ring-fenced” to fund NHS ART cycles which may lead to reductions in HMPs in the UK. The study recommends the establishment of a UK National Database for HMP and offering early psychological support, especially to female patients, whose QoL approaches levels observed in clinical depression.

Authors: Batwala, M

• Type of award: MSc by Research
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: IVF; Clinical Commissioning Group (CCG); Fertility Investigations; CCG; Clinical Commissioning Groups; QoL; Heterosexual; National Health Service; High Multiple Pregnancy; NHS funding; ART; Patient Pathways; Traditional Fertility Clinic; Fertility Clinic; Multiple Pregnancy; UK treatment; High Multiple Pregnancies; Savings to NHS; One-stop Clinic; NHS; Savings to CCG; Heterosexual couples; Conventional NHS pathway; Conventional Fertility Clinic; HMP; Couples; International treatment; Assisted Reproductive Technology; In-vitro Fertilisation; Traditional NHS pathway; Clinical Commissioning Group; Health Economics; One-stop Fertility Clinic; One-stop Pathway; Quality of Life; CCG funding
• Subjects: Fertility clinics; Patient satisfaction; Fertility, Human; Multiple pregnancy; Heterosexuals; Quality of life; Economics; Finance; Reproductive health services; National health services; Medical tourism