Estimating the government public economic benefits attributed to investing in assisted reproductive technology: a South African case study

Abstract

Limited resources and high treatment costs are arguments often used in many public health systems in low-and middleincome countries to justify providing limited treatments for people with infertility. In this analysis, we apply a government public economic perspective to evaluate public subsidy for in-vitro fertilization (IVF) in South Africa. A fiscal model was developed that considered lifetime direct and indirect taxes paid and government transfers received by a child conceived by IVF. The model was constructed from public data sources and was adjusted for mortality, age-specific educational costs, participation in the informal economy, proportions of persons receiving social grants, and health costs. Based on current proportions of individuals receiving social grants and average payments, including education and health costs, we estimate each citizen will receive ZAR513,165 (USD35,587) in transfers over their lifetime. Based on inflated age-specific earnings, we estimate lifetime direct and indirect taxes paid per citizen of ZAR452,869 (USD31,405) and ZAR494,521 (USD34,294), respectively, which also includes adjustments for the proportions of persons participating in the informal economy. The lifetime net tax after deducting transfers was estimated to be ZAR434,225 (USD31,112) per person. Based on the average IVF investment cost needed to achieve one live birth, the fiscal return on investment (ROI) for the South African Government is 5.64. Varying the discount rate from 4% to 7%, the ROI ranged from 9.54 to 1.53, respectively. Positive economic benefits can emanate from public financing of IVF. The fiscal analytic framework described here can be a useful approach for health services to evaluate future public economic benefits.

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

“…However, infertility is itself a widely prevalent cause of significant health burden for millions of people ( Makuch et al , 2010 ; Mascarenhas et al , 2012 ; Cox et al , 2022 ) that should be the addressed alongside other health needs to achieve universal health coverage ( Starrs et al , 2018 ). The results of this review add to the calls for governments in LMICs to increase investments in the provision of fertility treatment, by better integrating infertility in the national health policy and financing ( WHO, 2020 ; Connolly et al , 2021 ). Yet, in comparison with HICs, this review demonstrates that there are limited data on costs of ART from LMICs to inform policies and financing.…”

“…ART financing by the governments in LMICs depends mainly on the cost–benefit value perceived by the state, given the relatively high ART costs ( Darvishi et al , 2020 ). 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 ).…”

Estimating the effects of policies on infertility prevalence worldwide

“…In low- and middle-income countries, limited ART treatments are provided for infertile people because of limited resources and high treatment costs. However, a South African case study estimating the government public economic benefits attributed to investing in ART suggested that funding for IVF may create positive economic benefits and promote the sustainability of health systems [ 24 ].…”

Access to infertility care services towards Universal Health Coverage is a right and not an option

“…However, in the policy-making space, differential power existed; United Nations agencies for example play an important role on both SRH and UHC issues, depending on their international norms and guidelines. Priority-setting process theoretically allows a diverse range of healthcare stakeholders to articulate their preferred values and agendas in order to achieve consensus on the direction for a country's health agenda [23]. However, based on the interviews it was noted that the key SRH partners expressed divers contributions in the process of infertility care services prioritization and its inclusion within the Health Benefit Package (HBP).…”