What is a Cost Effective Approach?

by Bradley J Van Voorhis, MD


Few cost-effectiveness studies about infertility treatment have been published; however, the available studies share some common findings. This article reviews the published literature and discusses the cost-effectiveness of various approaches to infertility treatment. In the absence of tubal blockage and severe male factor infertility, use of intrauterine inseminations and human menopausal gonadotropin (hMG) injections are more cost-effective than in vitro fertilization (IVF). IVF is at least as cost-effective as tubal surgery. Although IVF costs are high, they fall well within the range of those for other accepted medical treatments and below the upper limit of what the general public is willing to pay for these treatments. Cost-effectiveness analysis is an important means of improving quality of care while controlling costs. Further work regarding cost-effectiveness of treatments among different diagnostic groups of infertile patients is needed. [Drug Benefit Trends 10(7):20, 22-29, 1998. © 1998 SCP Communications, Inc.]


Infertility is defined as failure to conceive after 1 year of unprotected intercourse. It is a common disorder, affecting 10% of couples in the US. Low sperm count or motility, blocked fallopian tubes from previous infection or surgery, and lack of ovulation are among the causes. In many couples, no cause for infertility can be found, even with intensive evaluation. Despite the prevalence of infertility, insurance coverage for its treatment is uncommon in the US. Currently only 12 states have laws regarding insurance coverage of infertility treatment. Although several states require comprehensive coverage, including in vitro fertilization (IVF), many other states have restrictions on the procedures that are covered. In addition, many insurance plans are exempt from having to provide coverage, or they set limits on the amount that will be reimbursed.

The costs of infertility evaluation and treatment are frequently passed directly to the patient because of limited insurance coverage. Often, the physician and patient must make infertility treatment decisions based on economic considerations rather than strictly on medical criteria. This underscores the importance of understanding the economics and cost-effectiveness of treatments offered to infertile couples.

Determination of Costs for Treatment

In performing a cost-effectiveness analysis for infertility treatment, a number of different costs may be included in the analysis. Costs to be considered include direct medical costs, direct nonmedical costs, indirect morbidity and mortality costs, and intangible costs[1-3] (B.J. Van Voorhis, MD, D.W. Stovall, MD, B.D. Allen, MD, et al, unpublished data). The types of direct medical costs usually taken into account include those for hospitalization, drugs, physician fees, laboratory tests, and radiologic procedures. Calculating the direct medical costs of infertility care is more complicated than calculating the costs for other medical conditions because it is necessary to consider both the costs of the infertility treatment and those incurred by the infants resulting from the treatment; a substantial consideration in infertility treatment is the cost of neonatal care for prematurely born multiple gestations resulting directly from these treatments.

Table of Contents
1. Cost Effective Approach
2. How much will IVF cost me?
3. A 'good prognosis' costs how much less?
4. If you're younger, it works out cheaper
5. Why is IUI more affordable?
6. Over 38? It may cost more.
7. Fertility Economics
8. Discouraged? IVF success rates increasing.
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