Acceptable cost for the patient and society

Alongside the debate around clinical, scientific, and ethical aspects of assisted reproductive technology (ART), there exists a parallel debate around the economics of ART treatment and what is the most appropriate funding framework for providing safe, equitable, and cost-effective treatment. The cost of ART treatment from a patient perspective exhibits striking differences worldwide due to the costliness of underlying health care systems and the level of public and third-party subsidization. These relative cost differences affect not only who can afford to access ART treatment but how ART is practiced in terms of embryo transfer practices; in turn significantly impacting the health outcomes and costs of caring for ART conceived children. Although empirical evidence indicates that ART treatment is "good value money" from a societal and patient perspective, the challenge remains to communicate this to policy makers, primarily because fertility treatments are not easily accommodated by traditional health economic methods. Furthermore, with global demand for ART treatment likely to increase, it is important that future funding decisions are informed by what has been learned about how costs and economic incentives influence equity of access and clinical practice. In this review we provide an international perspective on the costs and consequences of ART and summarize key economic considerations from the perspective of ART patients, providers, and society as a whole in the coming decade.