Literature summary of costs
Modified from: Human Reproduction, Vol. 17, No. 12, 3090-3109, December 2002
Economic implications of assisted reproductive techniques: a systematic review by: L. Garceau, J. Henderson, L.J. Davis, S. Petrou, L.R. Henderson, E. McVeigh, D.H. Barlow, L.L. Davidson. http://humrep.oxfordjournals.org/cgi/content/full/17/12/3090
Author(s) (year)/country of publication | No. of observations | Focus of study | Description of study | Costs | Comments |
Neumann et al. (1994)/USA | General population of couples undergoing IVF and two subgroups. | Costs of a successful delivery with IVF. | Modelling study based on listing of charges from six large IVF facilities and assumptions about complication and multiple birth costs. Probability of delivery based on literature. | Cost per live birth: First cycle IVF £52 566 Sixth cycle IVF £90 112 | IVF cycle costs based on charges. Includes estimates for NICU. |
Stern et al. (1995)/Israel | Cost calculation based on 500 cycles/year in an IVF unit at Hadassah University Hospital. | Cost analysis of IVF in Israel. | Annual expenditures of an IVF unit in Israel; based on a theoretical cohort of 500 cycles. Calculated IVF cycle cost and cost of "take-home baby". Included direct and indirect medical costs. | Total cost of an IVF cycle: £1915 Total cost of a "take-home baby": £14 401 | Analysis included maternal complication and multiple birth costs, as well as loss of working days. Based on hospital costs, not charges. |
Griffin and Panak (1998)/ USA | Eight large health maintenance organizations + indemnity plan. | Cost of infertility-related services. | Diagnostic codes relevant to infertility management were examined and combined with charges from indemnity plan across years 1986-93. | IVF/ GIFT £6115 ZIFT £7644 Cryopreservation £1529 | Cites Neumann et al. (1994) for costs. Makes assumptions about proportion of specific treatments related to infertility. |
Granberg et al . (1998)/ Sweden, Denmark, Norway, Finland, Iceland | 15 392 cycles. | Financing of IVF in public and private care systems. | Mean costs of each procedure calculated for each country. | Stimulated IVF £1392–2900 Singleton delivery £696–1160 Twins £1044£2320 Triplets £1392–2900 | Charges from clinics, not true costs. Excluded costs of multiple births. |
Summary of studies included in review (at 1999/ 2000 prices): economic evaluations.
Modified from: Human Reproduction, Vol. 17, No. 12, 3090-3109, December 2002
Economic implications of assisted reproductive techniques: a systematic review by: L. Garceau, J. Henderson, L.J. Davis, S. Petrou, L.R. Henderson, E. McVeigh, D.H. Barlow, L.L. Davidson. http://humrep.oxfordjournals.org/cgi/content/full/17/12/3090
| Author(s) (year)/country of publication | No. of observations | Focus and methods of study | Costs | |
| Comparison between different populations | ||||
| Trad et al. 1995/USA | 182 couples, 308 cycles, 73 allocated to 1 of 3 prognostic groups. | Probability of successful IVF in 3 prognostic groups. Retrospective reivew of patient records. | IVF £5986. | |
| Suchartwatnachai et al., (2000)/Thailand | 407 women, 722 stimulated cycles. | Cost effectiveness of IVF in women aged <38 compared to 38 years. Retrospective cohort study. | IVF £677–1354 | |
| Daya et al. 1995/Canada | 240 natural cycles; number of women not stated. | Cost effectiveness of natural cycle IVF (patient population) versus stimulated IVF (from literature). | Stimulated IVF £4250 Natural cycle IVF £898 | |
| Nargund et al. 2001/UK | 52 women, 181 cycles. | Natural cycle IVF based on prospective cohort compared with stimulated IVF from Tan et al.(1992). | Stimulated IVF £1786 Natural cycle IVF £413 | |
| Goeree et al. 1992/Canada | 399 couples, 205 undergoing IVF, 194 awaiting IVF. | RCT of couples undergoing IVF versus those awaiting IVF but receiving other treatment. | Pre-treatment evaluation £521 IVF £2531 | |
| Peskin et al. 1996/USA | 23 shared oocyte cycles; number of women not stated. | Cost effectiveness of shared oocytes IVF based on retrospective data compared with routine IVF from Goldfarb et al. (1996). | IVF £6880 Hospital costs for twins £1438, triplets £6951 neonatal costs per day £4173 | |
| Mantovani et al. 1999/Italy | Theoretical cohort of 10 000 patients with a 1-year time horizon. | Comparison of cost effectiveness of recombinant versus urinary FSH using Markov modelling. | Drug cost per cycle: rFSH £1346 uFSH £631 | |
| Sykes et al. 2000/UK | 585 women received rFSH, numbers receiving uFSH not stated. | Comparison of cost effectiveness of recombinant versus urinary FSH using Markov modelling. | Resource use data from Delphi panel, 20 UK IVF clinics generated ‘cost’ data. | |
| Van Loon et al. 2000/Greece | Theoretical cohort. | Comparison of cost effectiveness of recombinant versus urinary FSH using Markov modelling. | IVF with rFSH £4368 IVF with uFSH £3750 | |
| Van Voorhis et al. (1995)/USA | 610 women, 1000 oocyte retrievals Costs–334 initiated ART cycles. | IVF, GIFT and ZIFT cryopreservation compared with fresh embryo transfer. Retrospective review of patient records. | IVF £6364 GIFT £5277 ZIFT £7815 Cryopreservation £355 Embryo transfer £1247 Cryopreserved embryo cycle £1602 | |
| Fridstrom et al. (1999)/Sweden | 28 infertile women with clomiphene-resistant polycystic ovary syndrome (PCOS). 15 women (41 cycles) had OI 13 women (30 cycles) had IVF. | Women referred to a university clinic prospectively randomized to OI or IVF. | IVF £1241 OI £753 Complications £687 Twin delivery £349 Triplets £364 | |
| Karande et al. (1999)/USA | IVF group n = 46 Standard infertility treatment algorithm (SITA) n = 50 | Outcome and cost effectiveness of IVF compared with a standard infertility treatment algorithm when used as first-line therapy for couples with infertility. RCT | IVF £9755 SITA £6812 | |
| Peterson et al. (1994)/USA | 47 hMG + IUI patients (99 cycles); 19 IVF patients (19 cycles); 21 patients receiving no treatment. | Comparison of effectiveness and cost effectiveness of 1-4 cycles of ovulation induction with hMG + IUI versus one cycles of IVF versus no treatment. Prospective, non-randomized, cohort study, follow-up for 1 year. | IVF £5529 per cycle hMG + IUI £1103 per cycle | |
| Zayed et al. (1997)/UK | 38 couples had stimulated IVF. 42 couples had stimulated IUI treatment. | Cost effectiveness of SIUI treatment compared with SIVF in couples with unexplained and mild male factor infertility. Prospective trial. | SIVF £1005 per cycle SIUI £409 per cycle Embryo transfer £109 | |
| Goverde et al. (2000)/Netherlands | 86 couples IUI in spontaneous cycles; 85 stimulated IUI; 87 IVF. | Comparison of natural and stimulated IUI with IVF for couples with idiopathic or male subfertility. RCT. | IVF £1220 Natural cycle IUI £227 Stimulated IUI £339 | |
| Van Voorhis et al. (2001)/USA | 1039 couples 3479 IUI cycles; 424 couples 551 IVF cycles. | Comparison of effectiveness and cost effectiveness of IUI versus IVF based on semen analysis results. | IUI £260-930 IVF £4953-8673 | |
| Khare et al. (1995)/USA | Theoretical model. | Theoretical pathways for diagnosis and treatment of hysterosalpinges and pelvic adhesions. | IVF £5612 Laparoscopy £2304-3367 | |
| Copperman et al. (1996)/USA | 98 women; 67 underwent 92 cycles of IVF; 31 had tubal surgery. | Cost effectiveness of IVF versus tubal surgery for women with tubal disease. Cohort study. | Pre-treatment evaluation £379 for IVF, £264 for surgery. IVF £4456 Surgery £3590 Complications £7644 | |
| Mol et al. (2001)/Canada | 2167 couples in the Canadian Infertility Treatment Evaluation Study database. | Decision analytic analysis comparing hysterosalpingography (HSG), laparoscopy, IVF and Chlamydia antibody testing. | HSG £56 Laparoscopy £547 IVF £5520 (Neumann et al., 1994) Hospital costs: Singletons £6797 Twins £26 222 (Callahan et al., 1994) | |
| Silva et al. (1998)/USA | 22 women aged 40 + years, 24 GIFT cycles. | GIFT patient series. Comparison with SART data on donor oocyte IVF. | GIFT £4328 ± £609. Donor oocyte: £8625 Legro et al., 1997) | |
| Granberg et al. (1996)/Sweden | 715 couples started 901 ICSI treatments, 608 couples underwent 1949 donor inseminations. | Cost effectiveness of ICSI-IVF versus donor insemination (DI). Retrospective cohort study. | ICSI-IVF £3121 Donor insemination £582 Singleton delivery £839 Twins £1353 triplets £1950 | |
| Schlegel (1997)/USA | 710 cycles of IVF at four centres, 928 men who underwent varicocelectomy in 12 trials. | Cost effectiveness of ICSI-IVF versus varicocelectomy based on four centres for IVF and secondary data from controlled trials. Modelling study. | Pre-treatment evaluation £267-382 ICSI-IVF £8473 Varicocelectomy £3007 Complications £1143-1871 Singleton delivery £7366 Twins £6951 Triplets £82 126 | |
| Pavlovich and Schlegel (1997)/USA | 710 cycles of IVF at four centres, unstated numbers from five treatment series for microsurgical vasoepididymostomy and two series for microsurgical vasovasostomy. | Cost effectiveness of treatments for vasectomy reversal: ICSI-IVF versus microsurgical vasoepididymostomy versus microsurgical vasovasostomy. Modelling study. | Pre-treatment evaluation £183 ICSI-IVF £15 224-21 003 Vasovasostomy £5074 Vasoepididymostomy £9765 Complications £40 Singleton delivery £3536 | |
| Kolettis and Thomas (1997)/USA | 55 men underwent 58 vasoepididymostomies, secondary data from four studies of ICSI–IVF. | Comparison of vasovasostomy versus microepidydymal sperm aspiration (MESA) ICSI–IVF. Retrospective cohort. | Vasoepididymostomy £6282 ICSI-IVF not stated Singleton delivery £4752 Twins £14 780 Triplets £147 804 | |
| Donovan et al. (1998)/USA | 27 men with unsuccessful vasectomy reversal. | Comparison of microepidydymal sperm aspiration (MESA) ICSI-IVF with repeat vasectomy reversal. Case series. | MESA-ICSI-IVF £11 998 Vasectomy reversal £5807 | |
| Deck and Berger (2000)/USA | 42 men underwent vasectomy reversal, comparison with published literature. | Comparison of vasectomy reversal with ICSI-IVF in men with female partners aged >37 years. | ICSI–IVF £5629–8497 Vasectomy reversal £3285 | |
| Philips et al. (2000)/UK | Theoretical cohort. | Cost effectiveness of treatment alternatives for five main causes of infertility. Modelling study. | Costs per couple: Pre-treatment evaluation £358 IVF £1786-5749 ICSI £2664-5278 Ovulatory disorders £524 2644 SIUI £1634-2148 DI for male factor £1672 SDIU for male factor £2148 | |
| NICU = Neonatal intensive care unit. | ||||
This below study was looking at the costs of IVF treatment in the USA, Canada, UK, Scandinavia, Japan and Australia
Variable | USA | Canada | UK | Scandinavia | Japan | Australia |
Fresh transfer cycle (Total costs) | 12,513 | 8,500 | 6,534 | 5,549 | 3,956 | 5,645 |
Medications | 3154 | 3528 | 1758 | 1573 | 516 | 999 |
Procedures and services | 9358 | 4972 | 4776 | 3976 | 3440 | 4646 |
Frozen-thawed cycle | 3035 | 2380 | 1560 | 1347 | 1108 | 1648 |
ICSI | 1626 | 1172 | 1339 | 614 | 860 | 469 |
Assisted hatching | 705 | 349 | 675 | 339 | 271 | 207 |
Blastocyst culture | 379 | 247 | 678 | 458 | 632 | 508 |
