Economic aspects of infertility treatment

Sammanfattning: Background: With the expansion of IVF into general clinical practise during the 1980's and 1990's, the interest to identify and compare costs of different infertility treatments increased and, in many countries there is an ongoing debate about whether or not in vitro fertilisation (IVF) and other assisted reproductive techniques (ART) should be covered by national health insurance schemes. Objective: The aim of the present study was to examine aspects of cost in relation to effectiveness and benefits of infertility treatment, with particular emphasis on in-vitro fertilisation. Methods: Through retrospective studies the costs and proportions of public and private financing of IVF treatments in the Nordic countries were analysed [Paper I], the cost-effectiveness of treatments of male infertility i.e. donor insemination (DI) versus intra cytoplasmic sperm injection (ICSI) [Paper III] and for female infertility tubal damage i.e. tubal surgery versus IVF [Paper V] were evaluated and the cost-benefit of treatment for infertile couples was studied using the willingness-to-pay (WTP) instrument [Paper II]. Cost-effectiveness of treatment for clomiphene resistant polycystic ovary syndrome (PCOS) i.e. ovulation induction (OI) versus IVF [Paper IV] was estimated using a prospectively randomised study design. Results: The proportions of publicly and privately financed costs for IVF treatments were similar throughout the Nordic countries in 1994 and the publicly financed proportion was less then 0.1% of the total health care costs. By up-dating the Swedish data to 2001, it was shown that the publicly financed proportion is still very small, 0.14 %. For male infertility IVF was less cost-effective than DI in 1994 and remained the same for 2001. The number of ICSI cycles has increased since 1994 while the number of DI cycles has decreased. The major change in relation to costs was that the cost per started DI cycle had doubled in 2001 as compared to 1994. For treatment of PCOS, IVF was more cost-effective than OI although the cost per started treatment was lower for OI. Estimation of the incremental cost per live birth after IVF over OI was lower than the average cost for a live birth after IVF. The cost-effectiveness of treatment for female infertility due to tubal damage was similar for both surgery and IVF. The incremental cost per live birth of IVF over surgery was in the same range as the average costs. When utilising the WTP instrument the sum that infertile couple's were willing to spend was the same irrespective of the price per treatment. The study indicated that couples WTP for a child was higher than the actual direct medical costs for the health care system. Conclusions: IVF is a cost-effective treatment of infertility and the benefit of IVF for infertile couples, as measured by WTP is high in relation to the cost of treatment. The overall proportion of public health care spending on IVF is small and that further restrictions on fund allocation will probably result in limited financial impact or gain.