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

被引:287
作者
Chambers, Georgina M. [1 ]
Sullivan, Elizabeth A. [1 ]
Ishihara, Osamu [2 ]
Chapman, Michael G. [3 ,4 ]
Adamson, G. David [5 ]
机构
[1] Univ New S Wales, Perinatal & Reprod Epidemiol Res Unit, Sch Womens & Childrens Hlth, Randwick, NSW 2031, Australia
[2] Saitama Med Univ, Dept Obstet & Gynecol, Fac Med, Moroyama, Saitama, Japan
[3] Univ New S Wales, Discipline Obstet & Gynecol, Sch Womens & Childrens Hlth, Royal Hosp Women, Randwick, NSW 2031, Australia
[4] St George Private Hosp, IVFAustralia So Sydney, Kogarah, NSW, Australia
[5] Fertil Physicians No Calif, San Jose, CA USA
基金
英国医学研究理事会;
关键词
Assisted reproductive technologies; IVF; cost/cost-effectiveness; utilization; regulation; policy; IN-VITRO FERTILIZATION; SINGLE EMBRYO-TRANSFER; INSURANCE-COVERAGE; MULTIPLE BIRTHS; UNITED-STATES; COST; IVF; CARE; ART; PREFERENCES;
D O I
10.1016/j.fertnstert.2009.04.029
中图分类号
R71 [妇产科学];
学科分类号
100211 [妇产科学];
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 $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an lVF cycle after government subsidization ranged front 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. (Fertil Steril (R) 2009;91:2281-94. (C) 2009 by American Society for Reproductive Medicine.)
引用
收藏
页码:2281 / 2294
页数:14
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