Assessing the cost of live birth per uterus transplant

The total cost per live birth after a live donor uterus transplant has been estimated as €124,894, according to a recent study.

The research, published in Human Reproduction and conducted in Sweden, calculated the total cost by analysing nine uterus transplantation procedures. Uterus transplantation is a treatment option for people with absolute uterine factor infertility (AUFI), offering the possibility of pregnancy for women who are either missing a uterus or were born with a non-functional one. The first live birth from this procedure was achieved in 2014 (see BioNews 775).

'This study presents the first estimation of costs per live birth in uterus transplantation, finding a total cost per child of €124,894, with over half of the costs attributed to preoperative investigations and surgeries,' the authors concluded. 'Cost estimations for novel medical procedures, such as uterus transplants, are essential for discussions on affordability and prioritisation within healthcare systems.'

The new research is a follow-up to a 2021 study by the same authors, which estimated costs up to two months after surgery. Also published in Human Reproduction, this earlier study calculated the average cost per procedure to be around €74,000, including preoperative interventions, surgery, postoperative care and sick leave costs for donors and recipients.

Dr Thomas Davidson, associate professor in economics and health technology assessment at Linköping University, Sweden, and first author of the 2021 paper, said: 'In terms of priorities, this study is important because it contributes key data for deciding whether to offer uterine transplants within publicly funded health care. A cost estimate is the starting point for upcoming assessment of whether the intervention is cost-effective.'

The recent study expanded on this by including all expenses from pre-transplant screening to postnatal care, including surgeries, immunosuppression, IVF treatment, prenatal care, caesarean sections, postnatal care, hysterectomies and follow-up visits. Of the nine transplant recipients, seven were surgically successful while two resulted in early graft failures. Of the seven who were successful, six gave birth to a total of nine children, while one had multiple implantation failures and repeated miscarriages. If only surgically successful transplants were considered, the total cost was €107,120.

The study compared uterus transplantation costs with those of gestational surrogacy. In the USA, surrogacy can cost up to US$200,000, while in lower-income countries, the costs are more comparable to uterus transplantation in Sweden. However, the researchers noted that uterus transplantation has several advantages over surrogacy including fewer ethical and legal concerns.

In this study the surgical success rate was seven out of nine (78 percent), however, with improvements in surgeries including robotic-assisted transplants, the researchers predict that in future success rates could increase to over 90 percent.

'Despite challenges posed by resource constraints, uterus transplants trials worldwide have shown promising results, warranting further exploration of its cost-effectiveness,' the researchers concluded. 'Moving forward, ongoing refinements in UTx procedures are anticipated to reduce costs and enhance outcomes, positioning UTx as a viable option for women with AUFI.'