The economic impact of assisted reproductive technology: a review of selected developed countries.

摘要

OBJECTIVE: To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. DESIGN: Comparative policy and economic analysis. PATIENT(S): Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. OUTCOME MEASURE(S): Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. RESULT(S): Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from Dollars 12,513 in the United States to Dollars 3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom (Dollars 41,132 and Dollars 40,364, respectively) and lowest in Scandinavia and Japan (Dollars 24,485 and Dollars 24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. CONCLUSION(S): Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.