Valuing Insurance Coverage for Infertility Treatment: A Double-Bounded Contingent Valuation Study in Kermanshah, Iran

Infertility imposes substantial medical, psychological, and financial burdens. Despite recent expansion of insurance coverage for infertility services in Iran, evidence on public willingness to contribute to pooled insurance arrangements remains limited. This study estimated willingness to pay (WTP) for infertility insurance among adults in Kermanshah, western Iran, and identified associated determinants.

A cross-sectional contingent valuation study was conducted among 630 adults recruited via convenience sampling in Kermanshah. WTP for a hypothetical package covering 70% of infertility treatment costs (up to two cycles/year) was elicited using a double-bounded dichotomous choice (DBDC) format (bids: 4,000-16,000 thousand IRR). Mean WTP was estimated via maximum-likelihood interval-data regression. Sensitivity analyses evaluated gender composition and response certainty.

Of 626 valid respondents, 85.5% expressed positive WTP. Acceptance declined monotonically with increasing bids, supporting construct validity. Mean monthly WTP was 11,107 thousand IRR (95% CI: 10,212-12,003; base) and 11,266 thousand IRR (95% CI: 10,317-12,216; n=451, adjusted). Higher education (β=3,145.56, P=0.011) and socioeconomic status (β=5,254.04, P<0.001) predicted greater WTP; government-funding expectations (β=-5,046.92, P=0.004) and basic insurance (β=-3,697.27, P=0.050) predicted lower WTP. Certainty-calibrated and gender-balanced analyses confirmed robustness.

Adults in Kermanshah expressed substantial support for infertility insurance. Given the single-city convenience sample, generalization requires caution. Findings suggest that affordability, socioeconomic gradients, and public expectations regarding government responsibility should be considered in benefit-package and financing design.