Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Elena Keller; Willings Botha; Georgina M Chambers

doi:10.3389/fgwh.2023.971553

Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Front Glob Womens Health. 2023 Mar 1:4:971553. doi: 10.3389/fgwh.2023.971553. eCollection 2023.

Authors

Elena Keller¹, Willings Botha¹, Georgina M Chambers¹

Affiliation

¹ Centre for Big Data Research in Health & National Perinatal Epidemiology and Statistics Unit, UNSW Sydney, Sydney, NSW, Australia.

Abstract

Background: Using traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life.

Objective: The aim of this study was to develop a novel cost-benefit framework to assess value for money of publicly funded IVF treatment; to determine the number of cost-beneficial treatment cycles for women of different ages; and to perform an incremental cost-benefit analysis from a taxpayer perspective.

Methods: We developed a Markov model to determine the net monetary benefit (NMB) of IVF treatment by female age and number of cycles performed. IVF treatment outcomes were monetized using taxpayers' willingness-to-pay values derived from a discrete choice experiment (DCE). Using the current funding environment as the comparator, we performed an incremental analysis of only funding cost-beneficial cycles. Similar outputs to cost-effectiveness analyses were generated, including net-benefit acceptability curves and cost-benefit planes. We created an interactive online app to provide a detailed and transparent presentation of the results.

Results: The results suggest that at least five publicly funded IVF cycles are cost-beneficial in women aged <42 years. Cost-benefit planes suggest a strong taxpayer preference for restricting funding to cost-beneficial cycles over current funding arrangements in Australia from an economic perspective.

Conclusions: The provision of fertility treatment is valued highly by taxpayers. This novel cost-benefit method overcomes several challenges of conventional cost-effectiveness methods and provides an exemplar for incorporating DCE results into HTA. The results offer new evidence to inform discussions about treatment funding arrangements.

Keywords: IVF treatment; Markov model; cost-benefit analysis (CBA); discrete choice experiment (DCE); health technology assessment (HTA); value of a statistical baby (VSB); willingness-to-pay (WTP).

Grants and funding

This work was supported by the Australian National Health and Medical Research Council under Grant APP1104543; and a scholarship from the University of New South Wales School of Women's and Children's Health. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report.