ESHRE: Is IVF good value for money? Why funding ART is good fiscal policy
2010年6月9日 - 08:01AM
ビジネスワイヤ(英語)
Embargo: Wednesday 9 June 2010 00:01 BST (GMT + 1:00)
Children conceived by Medically Assisted Reproduction (MAR) have
fiscal implications for government both in terms of future
government spending and tax revenue. Based on public funding to
conceive a MAR child - after factoring in education, future health
and pension costs, and future tax contributions of this child - the
discounted net tax revenue (the difference between future
government spending and tax revenue) of a child born in 2005 is
roughly €127,000 in today’s value. Considering an average treatment
cost of approximately €15,000 to conceive an IVF-child, this
represents an 8-fold return on investment (ROI) for governments
[1].
While the costs of MAR treatment represent a substantial
proportion of a patient’s annual disposable income, MAR typically
represents less than 0.25% of total national healthcare
expenditure. By comparison, obesity accounts for 10% and 2-4% of
total health care spending in the US and Europe respectively.
MAR treatments elicit significant medical, reproductive and
economic influence in developed countries with 3.5 million children
estimated to have been born worldwide since 1978. These children
make up a substantial proportion of national births with up to 4.1%
in Denmark and 3.3% in Belgium. In the US, Europe, and Oceania over
600,000 treatment cycles resulted in 120,000 children being born in
2005.
The European Society of Human Reproduction and Embryology
(ESHRE) Task Force on ‘Reproduction and Society’ reviewed the
economics of MAR to evaluate the benefits of funding of MAR for
society and to inform policy makers on effective, safe and
equitable financing of MAR. Dr. Mark Connolly and colleagues who
published this review paper in the journal Human Reproduction
Update based their findings on key epidemiological and economic
studies. Affordability of IVF is one of the main drivers of
treatment utilisation, choice of treatment, and embryo transfer
practices which ultimately influence the multiple birth rate and
infant outcomes. Although the poorer clinical outcomes are well
known, the indirect costs and hence the economic burden associated
with MAR multiple birth children -which may extend well beyond the
perinatal period - are less appreciated.
Lack of affordable treatment may force patients and clinicians
to opt for cheaper fertility treatments such as stimulated
intrauterine insemination and ovulation stimulation which have less
controllable means of minimising multiple births. If treatment is
appropriately funded, there is less of a financial incentive to
achieve pregnancy in a limited number of cycles. Additionally,
restricted treatment and limited financial access coerces some
patients to seek cross border reproductive treatment in countries
where cheaper or less restrictive treatments are offered. The ESHRE
Task Force on ‘Cross Border Reproductive Care’ showed in a recent
survey that, of those patients that sought cross border
reproductive care, only 13% received partial reimbursement and 4%
total reimbursement in their own country. Different standards of
care and less responsible embryo transfer practices are amongst the
risks patients’ face when going abroad [2].
Public funding of MAR ranges from virtually no subsidisation in
the US to funding of a limited number of cycles based on female age
in most European countries. Many politicians have justified limited
funding with the view that infertility is a socially constructed
need rather than a medical disorder. ‘The few studies we found on
financial access to treatment suggest that affordability is a
powerful determinant of whether couples will pursue treatment,’
recalls Dr. Connolly. The cost (as percentage of an individual’s
annual disposable income) of a single fresh MAR cycle can range
from 50% in the US to 20% in the UK and the Nordic countries. After
government subsidies the costs in the US remained unchanged, but
fell to 12% in the UK and in Scandinavia.
So far very few studies exist that have evaluated MAR children
in terms of fiscal implications, and although an 8-fold ROI for any
government is quite substantial, the ESHRE Task Force calls for
caution ‘these results need to be applied in a policy framework and
in the broad context of other governmental policies. The creation
of a child leads to increased government expenses in the
short-term, and the ROI in future taxes is not received until more
than 30 years later once these children enter the workforce.’
The authors conclude that the way MAR is subsidised in different
healthcare settings and for different patient groups has
far-reaching consequences for access to treatment, clinical
practice, and infant outcomes. MAR children deserve the best start
in life, and as discussed in this review, affordable treatment can
make economic sense as well.
[1] The costs and consequences of assisted reproductive
technology: an economic perspective. Human Reproduction Update.
doi:10.1093/humupd/dmq013. A pdf of the full paper can be obtained
on request.
[2] Cross border reproductive care in six European countries.
Shenfield F, et al., and the ESHRE Taskforce on Cross Border
Reproductive Care. Human Reproduction doi:10.1093/humrep/deq057. A
pdf of the full paper can be obtained at:
http://humrep.oxfordjournals.org/cgi/reprint/deq057v1?maxtoshow=&hits=10&RESULTFORMAT=1&title=cross+border&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Please acknowledge Human Reproduction Update as a source in any
articles.
ESHRE was founded in 1985 with a mission is to promote the
understanding of reproductive science and medicine. It does this
through facilitating research and the dissemination of research
findings in human reproduction and embryology to the general
public, scientists, clinicians, patient associations and key policy
makers across Europe. Human Reproduction and Human Reproduction
Update are monthly journals of ESHRE, and are published by Oxford
Journals, a division of Oxford University Press. For more
information visit ESHRE’s website at www.eshre.eu.
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