Comparison of Low Cost Versus Conventional Assisted Reproductive Technology Treatment: A Prospective Micro Costing Study

Arakkal, Darshana; Mascarenhas, Mariano; Mangalaraj, Ann M; Karthikeyan, Muthukumar; Prasad, Jasmin Helan; Kunjummen, Aleyamma T; Kamath, Mohan S

doi:10.1142/s2661318220500164

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…In this regard, financing ART may represent a good governmental investment by enhancing immediate reproductive health while also generating positive financial returns in future tax contributions, including in LMICs ( Connolly et al , 2021 ). Further opportunities to mitigate costs of treatment in low resource settings could include the implementation of low-cost options for ART ( Chiware et al , 2021 ); however, low cost should not lead to a compromise on quality ( Aleyamma et al , 2011 ; Arakkal et al , 2020 ). Another alternative would be for governments to collaborate with the private sector through public–private partnerships (PPPs) to finance ART.…”

Section: Discussionmentioning

confidence: 99%

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

Njagi

Groot

Arsenijevic

et al. 2023

Human Reproduction Open

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STUDY QUESTION What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries? SUMMARY ANSWER Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY Infertility treatment is largely inaccessible to many people in low-and middle-income countries (LMICs). Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN, SIZE, DURATION Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, CINAHL, EconLit, PsycINFO, LILACS and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the Gross Domestic Product (GDP) per capita or average income of respective countries. ART regulations and public financing mechanisms were analysed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the integrated quality criteria for review of multiple study designs (ICROMS). MAIN RESULTS AND THE ROLE OF CHANCE Of the 4,062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2,109 to USD18,592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS, REASONS FOR CAUTION Several included studies were not primarily designed to examine the cost of ART, and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage (UHC). STUDY FUNDING/COMPETING INTEREST(S) This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests. TRIAL REGISTRATION NUMBER This review is registered with PROSPERO, CRD42020199312. WHAT DOES THIS MEAN FOR PATIENTS? This review appraises the literature on the costs of assisted reproductive technology (ART) borne by individuals, its affordability, and the association with government financing and ART regulations, between 2001 and 2020. To assess affordability, we examined the correlation of the direct medical costs paid by patients for one ART cycle with the respective countries' Gross Domestic Product (GDP) per capita or average income. Based on the findings, it is concluded that there were significant inequities in access to ART, and many patients in LMICs are still unable to afford it due to prohibitive costs. Better policies and government financial mechanisms are needed to improve affordability for patients in LMICs.

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