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Objective: To assess the difference in cost between initial and second in vitro fertilization (IVF) cycles in the United Kingdom. Methods: This prospective time-motion analysis captured data on average time spent on 31 representative components of the IVF sequence as provided by clinical team members in seven categories. Audits of consumables and observations on personnel costs were made from total of 120 fertility patients undergoing initial or second IVF cycles (n=736) between 1 January 2002 and 31 December 2002 at a UK assisted fertility unit. Results: Patients spent an average of 16.71±4.3 hrs with staff during an initial IVF cycle, resulting in direct personnel costs of £577.05±151.01. When consumables were included, each initial cycle cost the clinic approximately £2246.57±151.01. For second IVF cycles, patients spent significantly less time with staff compared to their first IVF cycle (6.94±2.44 hrs; p<0.05), corresponding to £257.53±90.77 in personnel cost. Conclusions: This is the first economic appraisal of the IVF treatment sequence in the UK using a timemotion analysis model. Our study found that when combined with consumables, total institutional costs for second IVF cycles were significantly reduced when compared to initial cycles (£1813.12±90.77; p<0.05). Aggregating data from all IVF cycles performed within the fertility centre during the study interval, initial cycles were found to be front-loaded, resulting in £252,420 more in institutional costs as compared with subsequent IVF cycles. While these observations were registered in 2003, an inflation adjustment using recent European Commission Eurostat data for healthcare finds the difference between initial and subsequent fresh IVF cycles in present currency to be approximately £579.14 per cycle. Time-motion analysis can identify episodes of care that can be streamlined to improve outcomes and reduce cost. 1Center for Study of Multiple Birth, Chicago, Illinois USA; 2Vermont Center for Clinical and Translational Science, Global Health Economics Unit, University of Vermont, College of Medicine, Burlington Vermont USA; 3Center for Science and Society, Trinity College, University of Oxford, Oxford UK; 4University of Vermont College of Medicine, Department of Surgery, Burlington, Vermont USA; 5Senior Legal Advisor, Boehringer Ingelheim, Berkshire UK; 6Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University; Chicago, Illinois USA; 7Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine; Burlington, Vermont USA; 8Division of Reproductive Endocrinology, Pacific Reproductive Center; Irvine, California USA; 9School of Life Sciences, University of Westminster; London UK *Corresponding author dr.sills@prc-ivf.com

A Time-motion Comparison of Itemized Treatment Costs in First and Second In Vitro Fertilization Attempts: A United Kingdom Fertility Centre Experience