Georgina M Chambers1, Van Phuong Hoang2, Elizabeth A Sullivan2, Michael G Chapman3, Osamu Ishihara4, Fernando Zegers-Hochschild5, Karl G Nygren6, G David Adamson7. 1. National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: g.chambers@unsw.edu.au. 2. National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia. 3. School of Women's and Children's Health, Royal Hospital for Women, Sydney, New South Wales, Australia; IVF Australia, Sydney, New South Wales, Australia. 4. Department of Obstetrics and Gynecology, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan. 5. Clinica las Condes and Program of Ethics and Public Policies, University Diego Portales, Santiago, Chile. 6. Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 7. Palo Alto Medical Foundation Fertility Physicians of Northern California, Palo Alto, California; Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, California; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
Abstract
OBJECTIVE: To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred. DESIGN: Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices. SETTING: Not applicable. PATIENT(S): Women undergoing ART treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred. RESULT(S): ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles. CONCLUSION(S): The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices.
OBJECTIVE: To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred. DESIGN: Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices. SETTING: Not applicable. PATIENT(S): Women undergoing ART treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred. RESULT(S): ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles. CONCLUSION(S): The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices.
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