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Abstract
Assisted reproductive technologies (ART) are widely accepted as clinically effective in the treatment of infertility. However, there is a scarcity of economic information to influence decision making. Four studies were undertaken to inform public health policy and clinical practice in relation to equitable and effective resource allocation of ART. Study One used a detailed cost-analysis and decision-analytic model of Australian ART registry data to calculate age-specific costs per live-birth (all maternal ages; AUD 32,903). Study Two expanded the methodology to analyse economic aspects of ART in selected developed countries. Treatment costs reflected the costliness of the underlying healthcare system, with cycle costs highest in the US (USD 12,513) and lowest in Japan (USD 3956). ART was expensive from a patient, but not from a societal perspective. Demand was price elastic in the midrange of consumer prices (USD 3000-6000). Only countries with funding arrangements which minimised out-of-pocket expenses met expected demand. The main complication of ART is the high incidence of iatrogenic multiple births. Additionally, ART singletons have poorer perinatal outcomes than non–ART singletons. Study Three quantified the inpatient costs of ART versus non–ART deliveries in Australia. The poorer perinatal outcomes of ART singletons translated into 31% higher birth–admission costs for ART compared to non–ART singletons. The combined maternal and infant birth–admission costs of ART twins and triplets were 3 and 11 times higher than for singletons. Study Four was undertaken as a clinical and cost–effectiveness analysis of IVF versus stimulated intrauterine insemination (IUI). One IVF treatment was more effective than two cycles of IUI; cumulative live–birth rates (39% and 28%, respectively) and mean time to pregnancy (69 days and 44 days, respectively). IVF was more costly but more effective than IUI, with an incremental-cost-effectiveness-ratio of an additional live-birth well within society’s willingness-to-pay. This thesis provides the first detailed economic analysis of ART in Australia, and the most comprehensive economic review of ART among developed countries. The methodologies developed were used to cost the main complications of ART, and to indicate that IVF is more effective than IUI as a first-line therapy for subfertility.