A cost and outcome model of fertility treatment in a managed care environment.
OBJECTIVE
To build a financial model of a fertility practice operating under managed care.


METHODS
Financial model in Microsoft Excel (Redmond, Washington).


METHODS
University-affiliated infertility practice, assuming primary care referral of patients and total revenue a function of the capitation contract.


METHODS
Female infertility patients and their partners with assumed mean age of 35 years.


METHODS
Breakeven capitation rate.


RESULTS
Every other month ovulation induction produced the lowest breakeven capitation rates in the model. Breakeven capitation rates increased from $0.85 up to $4.70 per member per month as utilization increased from 0.1% to 1% of health plan members. Decreasing the cost of an IVF-ET cycle $2,050 decreased breakeven capitation rates from $0.05 up to $0.80 per member per month as utilization of fertility services increases from 0.1% to 1% of health plan members. Decreasing average yearly pregnancy rate from 56% to 41% increased breakeven capitation rate from $0.10 to $0.80 per member per month across similar utilization. The average cost of pregnancy per year ranged from $6,787 to $21,075.


CONCLUSIONS
As utilization of fertility services increases, cost reductions no longer exist to offset increasing breakeven capitation rates. Financial modeling, using actual data, can evaluate any medical decision in terms of outcome and the cost of that outcome. Modeling is an effective means for physicians to educate themselves concerning the cost of their fertility and medical decisions.
Rabin
D S
DS
Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois 60068, USA.
Qadeer
U
U
Steir
V E
VE
D002204:Capitation Fee; D003362:Cost-Benefit Analysis; D004624:Embryo Transfer / Q000191:economics; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008329:Managed Care Programs; D011247:Pregnancy; D018873:Pregnancy Rate; D012099:Reproductive Techniques / Q000191:economics*; D016896:Treatment Outcome