We determined the cost-effectiveness of a variety of assisted reproductive procedures during 1992 at the University of Iowa. Rather than estimating costs, we tabulated all medical charges for all patients from the time of the initial consult until intrauterine fetal cardiac activity was confirmed by ultrasound examination. Costs of all immediate complications of treatment were included in the analysis. Obstetric charges and lost wages were not included, since these data were often not available to us due to deliveries occurring in other hospitals.
Cryopreservation is cost effective
In 1992, we had an average cost of $8071 per initiated cycle and an ongoing pregnancy rate of 18.3% per initiated cycle. Our calculated cost per delivery was $44,200 for IVF-again, a lower figure than earlier estimates, largely because of higher pregnancy rates achieved. We also found that embryo cryopreservation and subsequent transfer is a very cost-effective practice. Transfer of cryopreserved embryos resulted in an 18% pregnancy rate per initiated cycle, and the cost per delivery was only $10,953 for these cycles. Cost savings were accrued for cryopreserved embryo transfer because ovarian stimulation and oocyte retrieval are not required, and hospital and physician charges are reduced accordingly (Table 2).
GIFT and ZIFT less expensive than IVF
We also discovered that other assisted reproduction procedures, including GIFT and ZIFT, were more cost-effective than IVF because of the higher pregnancy rates achieved with these techniques in our program. When considering all the ART procedures offered in our program in 1992, the overall cost per delivery was $30,252, and the cost per infant was $22,991.
Age is an important factor
An important variable in the cost-effectiveness of IVF is the woman's age. We found the cost per delivery to be $31,597 for women younger than 38 years. In contrast, for women 38 years of age or older, the cost per delivery was nearly triple, at $89,981. The use of donor oocytes is very cost-effective in older women, as the cost per delivery was $35,605 for those cycles despite the increased cost of paying for a donor. This reflects the well-documented efficacy of donor-oocyte cycles in older women.
In summary, the measured cost-effectiveness of IVF as a treatment for infertility is somewhat improved over the initial published estimate. The major reason for this is the improved pregnancy rates that have been seen over the years, particularly in large centers but also in the general experience of clinics throughout the US. It is likely that the cost-effectiveness of this treatment will continue to evolve as new discoveries lead to improvements in IVF success rates.
It is important to remember that IVF is a new technology, so continued advances in this field can be expected. Therefore, policy makers and insurance companies will need to continually monitor the cost-effectiveness of this procedure if they are to make valid conclusions and decisions regarding patient care and access to IVF treatment.