title: The economic impact of assisted reproductive technology: a review of selected developed countries.
abstract: OBJECTIVE
  To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries.
  
  
  METHODS
  Comparative policy and economic analysis.
  
  
  METHODS
  Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia.
  
  
  METHODS
  Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity.
  
  
  RESULTS
  Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity.
  
  
  CONCLUSIONS
  Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.
authors.affiliation: Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia. g.chambers@unsw.edu.au
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Chambers
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishihara
authors.forename: Michael G
authors.initials: MG
authors.lastname: Chapman
authors.forename: G David
authors.initials: GD
authors.lastname: Adamson
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics; D003365:Costs and Cost Analysis; D003663:Decision Trees; D003906:Developing Countries; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D006801:Humans; D007247:Infertility, Female / Q000191:economics*; D007564:Japan; D010361:Patients; D011153:Population; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D016896:Treatment Outcome; D014481:United States