The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

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Governments worldwide are searching for ways to cope with ageing populations as the demographic shift towards fewer and later births takes hold. The potential contribution of assisted reproductive technologies (ART) to increasing fertility rates has not yet been explored. This paper describes a preliminary study into the impact ART policies might have on population ageing. A deterministic model is developed to quantify the effects of ART policies on total fertility rate (TFR), and tested using data from the UK and Denmark. The population structure for 2050 is modelled to translate fertility rates into time-dependent population dynamics, and the costs of potential ART policies are investigated. If access to ART in the UK were increased to the level of Denmark, the TFR would increase by 0.04, from 1.64 to 1.68. The cumulative effect on the population structure would be a 1.7% decrease in old-age dependency ratio in 2050. Although the empirical models do not include behavioural components, the results demonstrate that ART does have potential to contribute to TFR and influence population structure, and that the direct costs associated with adopting ART as a population policy are comparable with those of existing policies commonly used by governments to influence fertility.

An investment of pound 12,931 to achieve an IVF singleton is actually worth 8.5-times this amount to the UK Treasury in discounted future tax revenue. The analysis underscores that costs to the health sector are actually investments when a broader government perspective is considered over a longer period of time.

Objectives: Investments in health research should lead to improvements in health and health care. This is also the remit of the main HTA program in the Netherlands. The aims of this study were to assess whether the results of this program have led to such improvements and to analyze how best to assess the impact from health research. Methods:We assessed the impact of individual HTA projects by adapting the "payback framework" developed in the United Kingdom. We conducted dossier reviews and sent a survey to principal investigators of forty-three projects awarded between 2000 and 2003. We then provided an overview of documented output and outcome that was assessed by ten HTA experts using a scoring method. Finally, we conducted five case studies using information from additional dossier review and semistructured key informant interviews. Results: The findings confirm that the payback framework is a useful approach to assess the impact of HTA projects. We identified over 101 peer reviewed papers, more than twenty-five PhDs, citations of research in guidelines (six projects), and implementation of new treatment strategies (eleven projects). The case studies provided greater depth and understanding about the levels of impact that arise and why and how they have been achieved. Conclusions: It is generally too early to determine whether the HTA program led to actual changes in healthcare policy and practice. However, the results can be used as a baseline measurement for future evaluation and can help funding organizations or HTA agencies consider how to assess impact, possibly routinely. This, in turn, could help inform research strategies and justify expenditure for health research.