Costs of infertility treatment: results from an 18-month prospective cohort study

Patricia Katz; Jonathan Showstack; James F Smith; Robert D Nachtigall; Susan G Millstein; Holly Wing; Michael L Eisenberg; Lauri A Pasch; Mary S Croughan; Nancy Adler

doi:10.1016/j.fertnstert.2010.11.026

Cost and Access Cost of Care

Costs of infertility treatment: results from an 18-month prospective cohort study

Katz P, Showstack J, Smith JF, Nachtigall RD, Millstein SG, Wing H, Eisenberg ML, Pasch LA, Croughan MS, Adler N

Published March 2011 Fertility and Sterility

DOI 10.1016/j.fertnstert.2010.11.026 PMID 21130988 PMC PMC3043157

RRM Academy Synopsis

IVF cost a median $24,373 per woman over 18 months in a US study

A cohort of 398 women at eight infertility practices found median 18-month costs ran from $1,182 for medications only to $24,373 for IVF and $38,015 for IVF with donor egg. Cost per successful outcome, a delivery or ongoing pregnancy, reached $61,377 for IVF. Within the study period, costs did not differ significantly between women with and without a successful outcome.

Key Findings

Median per-person treatment costs rose with the highest treatment used: medications only $1,182; IUI with clomiphene $3,595; IUI with gonadotropins $8,594; IVF $24,373; IVF with donor egg $38,015.
Treatment cost per successful outcome (delivery or ongoing pregnancy): medications only $5,894; IUI with clomiphene $10,696; IUI with gonadotropins $19,566; IVF $61,377; IVF with donor egg $72,642.
Among women who pursued cycle-based treatment, 105 had deliveries and 40 had ongoing pregnancies. The IVF group's success rate was 47.3%.
Multiple births made up 40.0% of deliveries in the IVF group and 57.1% in the IVF with donor egg group, compared with 7.1% and 9.5% in the two IUI groups.
In every treatment group, spending by women whose treatment succeeded and by women whose treatment did not succeed showed no significant difference.

Interpretation

This prospective cohort followed women from eight reproductive endocrinology practices in Northern California, mostly white and well educated. Of eligible women, 40.0% took part. Groups were set by the highest treatment each woman used, and they differ in diagnoses and age. Costs are standardized estimates built from 2006 fee schedules and medication price lists. The authors note the IVF figure excludes earlier treatment and any later spending by unsuccessful women, so it may be artificially low for them. The study describes costs and outcomes within groups.

RRM Context

IVF bypasses the reproductive system without resolving why conception fails, and this cohort documents what that route cost over 18 months. Records listed a male factor diagnosis for 38% of couples. Restorative reproductive medicine starts from the cause in both partners and treats it.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To examine resource use (costs) by women presenting for infertility evaluation and treatment over 18 months, regardless of treatment pursued.

Design

Prospective cohort study in which women were followed for 18 months.

Setting

Eight infertility practices.

Patients

Three hundred ninety-eight women recruited from infertility practices.

Interventions

Women completed interviews and questionnaires at baseline and after 4, 10, and 18 months of follow-up. Medical records were abstracted after 18 months to obtain details of services used.

Main Outcome Measures

Per-person and per-successful-outcome costs.

Results

Treatment groups were defined as highest intensity treatment use. Twenty percent of women did not pursue cycle-based treatment; approximately half pursued IVF. Median per-person costs ranged from $1,182 for medications only to $24,373 and $38,015 for IVF and IVF-donor egg groups, respectively. Estimates of costs of successful outcomes (delivery or ongoing pregnancy by 18 months) were higher--$61,377 for IVF, for example--reflecting treatment success rates. Within the time frame of the study, costs were not significantly different for women whose outcomes were successful and women whose outcomes were not.

Conclusions

Although individual patient costs vary, these cost estimates developed from actual patient treatment experiences may provide patients with realistic estimates to consider when initiating infertility treatment.

Topics

Cost and Access › Cost of Care › Treatment Costs · Assisted Reproduction › Industry, Cost and Access › Cost per Cycle

Patricia Katz, Jonathan Showstack, James F Smith, Robert D Nachtigall, Susan G Millstein, Holly Wing, Michael L Eisenberg, Lauri A Pasch, Mary S Croughan, Nancy Adler

Pat Katz, Trish Katz, P Katz, Jon Showstack, J Showstack, Jim Smith, Jimmy Smith, J Smith, Bob Nachtigall, Rob Nachtigall, Bobby Nachtigall, R Nachtigall, Sue Millstein, S Millstein, H Wing, Mike Eisenberg, M Eisenberg, L Pasch, M Croughan, N Adler

PMID 21130988 21130988 DOI 10.1016/j.fertnstert.2010.11.026 10.1016/j.fertnstert.2010.11.026 Katz et al. 2011, Katz 2011

Costs of infertility treatment: results from an 18-month prospective cohort study

IVF cost a median $24,373 per woman over 18 months in a US study

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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