Omkostninger ved assisteret befrugtning på specialiserede fertilitetsklinikker i det offentlige sundhedssystem: resultater fra et 5 års opfølgningsstudie

Objective: To estimate the costs to the public health care system of couples in medically assisted reproduction. Material and methods: Longitudinal cohort study among n=739 infertile couples who started a fertility treatment at one of four selected public fertility clinics in Denmark during the period January 2000 – August 2001. Data were collected prospectively by a self-administered questionnaire for both partners, and retrospectively from medical records through a 5 year follow-up study (ending 2005-2006) of each treatment at the chosen clinic. Cost data were collected from one of the participating clinics. Flow diagrams were drawn for each of three different treatment cycles: 1) in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with fresh embryos, 2) frozen/thawed embryo transfer cycle (FET), and 3) intrauterine insemination using partners’ semen (IUI-H) or donor semen (IUI-D). Direct costs at each step in the flow diagram were identified, measured and valuated in DKK through a bottom-up procedure. Indirect costs (in accounting sense) were allocated to each treatment cycle by a top-down method. While direct costs were measured in detail, the indirect costs were allocated on the basis of number of visits as key. Costs in 2001-prices were inflated to 2012 prices by using a constructed health sector price- and wage index. Results: A total of 434 live births with one or more children per birth were included. Average total costs per live birth in 2012-prices is estimated to 76,427 DKK, of which 65,790 are direct costs and 10,637 are allocated indirect costs to cover overhead costs of the hospital and use of space. Per treated couple – irrespective of whether the treatment ended with a live birth or not – average total costs are estimated to 46,953 DKK, of which 40,418 are direct costs and 6,535 are indirect costs.