Cost-benefit Analysis of IUI and IVF based on willingness to pay approach; case study: Iran

Abstract

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016–17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016–17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran.

What Features of Fertility Treatment do Patients Value? Price Elasticity and Willingness-to-Pay Values from a Discrete Choice Experiment

“…Among the publications reporting price elasticity estimates for fertility treatment summarized in OSM Table A5, only one study is based on stated-preference methods using contingent valuation. Unlike our results, elasticity estimates of the contingent valuation study suggest elastic demand for IVF and intrauterine insemination with the quantity demanded decreasing by 1.32-1.48% for every 1% increase in treatment costs [33]. Studies based on market data report more varied estimates: While some suggest elastic demand [34,37], others report inelastic demand [35,36] with positive price elasticities for some countries including Australia [36].…”

“…There is limited literature on price elasticities for fertility treatments which are based on either survey data from WTP studies [33] or empirical market data including changes in the quantity demanded due to the introduction of a policy intervention [34][35][36][37][38].…”

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

“…ART financing by the governments in LMICs depends mainly on the cost–benefit value perceived by the state, given the relatively high ART costs ( Darvishi et al , 2020 ). In this regard, financing ART may represent a good governmental investment by enhancing immediate reproductive health while also generating positive financial returns in future tax contributions, including in LMICs ( Connolly et al , 2021 ).…”

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

“…This implies that (1) expected costs of providing IVF treatment will outweigh expected benefits at some point and, therefore, suggests that there is a maximum number of cost-beneficial treatment cycles; (2) fertility treatment is less costbeneficial in older compared to younger women, i.e., a smaller number of cycles would provide good value for money. Only two studies have undertaken a form of CBA for fertility treatment but did not account for age or number of cycles performed (44,45).…”