The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate

Objective: To examine the costs and outcomes of infertility-related services in Massachusetts during a time of expanded use of assisted reproductive technology (ART). Design: Cost data were obtained from the Massachusetts Department of Insurance Rate-Setting Commission and 9 large group insurance plans for the period 1986-1993. Utilization and success rates of ART were examined, and the cost per live delivery with the use of ART in 1993 was estimated. Setting: The state of Massachusetts, in which access to infertility-related services has been mandated by law since 1989. Patient(s): The study population consisted of 8 large health maintenance organization plans and the Blue Cross/Blue Shield indemnity plan. Intervention(s): None. Main Outcome Measure(s): Per capita infertility-related expenditures, infertility-related expenditures as a percentage of total expenditures, live deliveries per initiated ART cycle, and cost per live delivery, Result(s): Expenditures for infertility services increased at a rate similar to or slower than inflation during the years 1988-1992. Increases were slowest in health maintenance organizations, probably as a result of provider arrangements. Infertility services accounted for 0.41% of total expenditures within the indemnity plan in 1993 (approximately $1.71 per contract-month). Examination of ART utilization showed no evidence of overutilization by patients with a low chance of success. The cost per live delivery with the use of ART in 1993 was $59,484. Conclusion(s): Mandated infertility coverage was associated with increased use of ART but not with excessive increases in consumer cost for infertility insurance coverage. (Fertil Steril(R) 1998;70:22-9. (C)1998 by American Society for Reproductive Medicine.).