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Economic Evaluation of Medically Assisted Reproduction: A Methodological Systematic Review.

Astrid Van Muylder1, Thomas D'Hooghe1, Jeroen Luyten1

  • 1Department Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium (AVM, JL); Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium (TD); Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine, New Haven, CT, USA (TD); Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany (TD). The review was written at the Leuven Institute for Healthcare Policy. It was presented at the ESHRE 38th Annual Meeting (Milan 2022). The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Astrid Van Muylder and Jeroen Luyten have no conflicting interests to declare. The participation of Thomas D'Hooghe to this publication is part of his academic work; he does not see a conflict of interest as Merck KGaA was not involved in writing this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge an internal funding from KU Leuven for this study. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Astrid Van Muylder and Jeroen Luyten.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|August 25, 2023
PubMed
Summary
This summary is machine-generated.

Health economic evaluations for medically assisted reproduction (MAR) are complex. Most studies focus on short-term, clinic-based cost-per-live-birth, omitting broader societal costs and outcomes.

Keywords:
cost-effectivenesscostseconomic evaluationeffectsmedically assisted reproduction

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Area of Science:

  • Health economics
  • Reproductive medicine

Background:

  • Medically assisted reproduction (MAR) presents unique challenges for health economic evaluations due to extensive, long-term costs and multiple stakeholders.
  • The complexity arises from a broad range of costs and outcomes, potentially spanning multiple generations.

Purpose of the Study:

  • To systematically review costs and outcomes in published MAR economic evaluations.
  • To compare these with health technology assessment (HTA) guidelines for different evaluation objectives.

Main Methods:

  • Systematic search of HTA guidelines and major databases (PubMed Central, Embase, WOS CC, CINAHL, Cochrane, HTA, NHS EED).
  • Analysis of economic evaluations of MAR published between 2010 and 2022.
  • Data extraction focused on included costs and outcomes, compared against HTA recommendations.

Main Results:

  • 93 cost-effectiveness estimates were identified, predominantly cost-per-live-birth (57%) from a clinic perspective (47%).
  • Few studies adopted societal perspectives or used quality-adjusted life-years (QALYs) (2%).
  • Broader evaluations frequently omitted relevant MAR costs and outcomes, with HTA guidelines lacking clear direction for several categories.

Conclusions:

  • Published MAR economic evaluations are typically short-term, clinic-focused, and cost-per-live-birth oriented.
  • Comprehensive, long-term, societal-perspective evaluations using metrics like cost-per-QALY are scarce and often incomplete.
  • Further methodological development in HTA is needed for MAR, alongside guidance for including a wider scope of costs and outcomes.