More on Cost Analysis
These researchers also performed a sensitivity analysis by varying the probabilities by 2% each way; they estimated that the cost per delivery for IVF would fall somewhere between a low of $55,143 and a high of $211,940. It is important to note that the conclusions of these researchers were based on estimates and not on actual costs and outcomes of IVF centers.
Subsequently published analyses suggest that the actual cost per delivery for IVF may be somewhat, although not markedly, lower than that estimated by Neumann and associates (Table 1). There are several reasons for the initial high estimate. For instance, the investigators used a low estimate of the pregnancy rate obtained using IVF. Recent improvements in embryo culture techniques and increased experience with this relatively new treatment have led to significantly higher pregnancy rates in many centers.
In addition, the report failed to account for the pregnancies that can result from cryopreserved embryos. Cryopreserved embryo transfer is much less expensive than transfer of "fresh" embryos, since the costs associated with ovarian stimulation and egg retrieval are avoided. Finally, many couples (particularly poor-risk couples) drop out of treatment, as opposed to continuing through 6 cycles of IVF, as assumed in some of the high-range estimates in the study.
In a cost-effectiveness study from Brigham and Women's Hospital, 182 patients were followed until they had achieved a pregnancy or completed a maximum of 3 IVF cycles. An ongoing pregnancy rate of 27% was found after the first cycle of treatment. Largely as a result of this higher pregnancy rate, a lower cost per delivery for IVF was found compared with that reported by Neumann and coworkers. Trad and coworkers calculated the cost per delivery to be $29,120 after 1 cycle and $31,590 after a maximum of 3 cycles of IVF.
Next, they calculated the different costs per delivery in patients with high, moderate, and low probability of pregnancy. These groupings were based on the woman's age and whether or not severe male factor infertility was present, since both of these are known prognostic factors for IVF pregnancies. The cost per delivery in this study was found to be $22,857, $34,000, and $42,666 for the high, moderate, and low probability groups, respectively.
This study demonstrated that IVF treatments become significantly more cost-effective in "good prognosis" patients because of improved pregnancy rates.