Valuing infertility treatment: Why QALYs are inadequate, and an alternative approach to cost-effectiveness thresholds

Keller, Elena; Chambers, Georgina M.

doi:10.3389/fmedt.2022.1053719

Cited by 8 publications

(9 citation statements)

References 86 publications

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“…Traditional health technology assessment (HTA) outcome metrics, which focus on health-related quality of life, such as cost per quality-adjusted life-years (QALYs) or disability-adjusted lifeyears (DALYs), are debatably inadequate when used for fertility treatments (21,29,30). Quality-adjusted life-years and DALYs were designed for, and thus are best suited to, measuring changes in health-related quality of life for already existing lives with utility weights derived from societal preferences for different health states (31).…”

Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

“…This only captures a component of the utility/disutility associated with fertility treatment, much of which is associated with non-health outcomes reflecting achieving life goals. Essentially, by undergoing fertility treatment individuals are buying hope to have a child and the potential to create a meaningful life, rather than improving health or avoiding disease (21,30,32,33). The challenges of using QALYs to value fertility treatment are highlighted by a review of cost-effectiveness analyses for fertility treatments (34) that showed that only one of 14 studies employed QALYs.…”

Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

“…Methodological challenges in economic evaluations of fertility treatments have been extensively highlighted in the literature (21,29,35). Cost-benefit analysis (CBA) which measures value in monetary units, is an alternative among existing HTA techniques that might be better equipped for an economic evaluation of therapies that create life, such as IVF treatment (29,30), and potentially overcomes the challenge of incorporating nonhealth-related benefits. Cost-benefit analysis allows incorporation of willingness-to-pay (WTP) values to capture the value associated with a health intervention and holistically reflects the health and non-health preferences of relevant stakeholders.…”

Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

“…The WTP per taxpayer for a live birth can be defined similarly to the value of a statistical life as the WTP for a marginal increase in the chance of having a babyalso called the value of a statistical baby (VSB) (30). The literature on VSB estimates is limited with only one study from 1994 reporting estimates as part of a feasibility study (59).…”

Section: Monetary Value Of a Babymentioning

confidence: 99%

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Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Keller

Botha

Chambers

2023

Front. Glob. Womens Health

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BackgroundUsing traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life.ObjectiveThe aim of this study was to develop a novel cost-benefit framework to assess value for money of publicly funded IVF treatment; to determine the number of cost-beneficial treatment cycles for women of different ages; and to perform an incremental cost-benefit analysis from a taxpayer perspective.MethodsWe developed a Markov model to determine the net monetary benefit (NMB) of IVF treatment by female age and number of cycles performed. IVF treatment outcomes were monetized using taxpayers' willingness-to-pay values derived from a discrete choice experiment (DCE). Using the current funding environment as the comparator, we performed an incremental analysis of only funding cost-beneficial cycles. Similar outputs to cost-effectiveness analyses were generated, including net-benefit acceptability curves and cost-benefit planes. We created an interactive online app to provide a detailed and transparent presentation of the results.ResultsThe results suggest that at least five publicly funded IVF cycles are cost-beneficial in women aged <42 years. Cost-benefit planes suggest a strong taxpayer preference for restricting funding to cost-beneficial cycles over current funding arrangements in Australia from an economic perspective.ConclusionsThe provision of fertility treatment is valued highly by taxpayers. This novel cost-benefit method overcomes several challenges of conventional cost-effectiveness methods and provides an exemplar for incorporating DCE results into HTA. The results offer new evidence to inform discussions about treatment funding arrangements.

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Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

Section: Inadequacy Of Traditional Health Technology Assessment Methodsmentioning

confidence: 99%

Section: Monetary Value Of a Babymentioning

confidence: 99%

See 2 more Smart Citations

Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Keller

Botha

Chambers

2023

Front. Glob. Womens Health

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“…We used standard HTA handbooks, guidelines, and articles 13,54–59 to determine the dominant view regarding which costs and outcomes are relevant to consider for each study objective (see Figure 1). Green checkmarks indicate which costs and outcomes should be included, while red crosses indicate those that should be excluded.…”

Section: Methodsmentioning

confidence: 99%

Economic Evaluation of Medically Assisted Reproduction: A Methodological Systematic Review

Van Muylder,

D’Hooghe,

Luyten

2023

Med Decis Making

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Background Medically assisted reproduction (MAR) is a challenging application area for health economic evaluations, entailing a broad range of costs and outcomes, stretching out long-term and accruing to several parties. Purpose To systematically review which costs and outcomes are included in published economic evaluations of MAR and to compare these with health technology assessment (HTA) prescriptions about which cost and outcomes should be considered for different evaluation objectives. Data Sources HTA guidelines and systematic searches of PubMed Central, Embase, WOS CC, CINAHL, Cochrane (CENTRAL), HTA, and NHS EED. Study Selection All economic evaluations of MAR published from 2010 to 2022. Data Extraction A predetermined data collection form summarized study characteristics. Essential costs and outcomes of MAR were listed based on HTA and treatment guidelines for different evaluation objectives. For each study, included costs and outcomes were reviewed. Data Synthesis The review identified 93 cost-effectiveness estimates, of which 57% were expressed as cost-per-(healthy)-live-birth, 19% as cost-per-pregnancy, and 47% adopted a clinic perspective. Few adopted societal perspectives and only 2% used quality-adjusted life-years (QALYs). Broader evaluations omitted various relevant costs and outcomes related to MAR. There are several cost and outcome categories for which available HTA guidelines do not provide conclusive directions regarding inclusion or exclusion. Limitations Studies published before 2010 and of interventions not clearly labeled as MAR were excluded. We focus on methods rather than which MAR treatments are cost-effective. Conclusions Economic evaluations of MAR typically calculate a short-term cost-per-live-birth from a clinic perspective. Broader analyses, using cost-per-QALY or BCRs from societal perspectives, considering the full scope of reproduction-related costs and outcomes, are scarce and often incomplete. We provide a summary of costs and outcomes for future research guidance and identify areas requiring HTA methodological development. Highlights The cost-effectiveness of MAR procedures can be exceptionally complex to estimate as there is a broad range of costs and outcomes involved, in principle stretching out over multiple generations and over many stakeholders. We list 21 key areas of costs and outcomes of MAR. Which of these needs to be accounted for alters for different evaluation objectives (determined by the type of economic evaluation, time horizon considered, and perspective). Published studies mostly investigate cost-effectiveness in the very short-term, from a clinic perspective, expressed as cost-per-live-birth. There is a lack of comprehensive economic evaluations that adopt a broader perspective with a longer time horizon. The broader the evaluation objective, the more relevant costs and outcomes were excluded. For several costs and outcomes, particularly those relevant for broader, societal evaluations of MAR, the inclusion or exclusion is theoretically ambiguous, and HTA guidelines do not offer sufficient guidance.

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Unmet Parenthood Goals, Health-Related Quality of Life and Apparent Irrationality: Understanding the Value of Treatments for Infertility

Skedgel

Cubí‐Mollá

Mott

et al. 2023

PharmacoEconomics Open

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An increasing number of prospective parents are experiencing infertility along with associated negative impacts on mental health and life satisfaction that can extend across a network of individuals and family members. Assistive reproductive technologies (ART) can help prospective parents achieve their parenthood goals but, like any health technology, they must demonstrate acceptable 'value for money' to qualify for public funding. We argue that current approaches to understanding the value of ART, including quality-adjusted life-year (QALY) gains based on changes in health-related quality of life (HRQOL) and, more often, cost per live birth, are too narrow to capture the full impact of unmet parenthood goals and ART. We see a fundamental disconnect between measures of HRQOL and broader measures of wellbeing associated with met and unmet parenthood goals. We also suggest that simple concepts such as 'patient' and 'carer' are of limited applicability in the context of ART, where 'spillovers' extend across a wide network of individuals, and the person receiving treatment is often not the infertile individual. Consideration of individual and societal wellbeing beyond HRQOL is necessary to understand the full range of negative impacts associated with unmet parenthood goals and the corresponding positive impacts of successful ART. We suggest moving towards a wellbeing perspective on value to achieve a fuller understanding of value and promote cross-sector allocative efficiency.

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Valuing infertility treatment: Why QALYs are inadequate, and an alternative approach to cost-effectiveness thresholds

Abstract: KEYWORDSinfertility treatment, quality-adjusted life-year (QALY), cost-benefit analysis (CBA), discrete choice experiment (DCE), willingness-to-pay (WTP), health technology assessment (HTA), value of a statistical baby (VSB)

Cited by 8 publications

References 86 publications

Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis

Economic Evaluation of Medically Assisted Reproduction: A Methodological Systematic Review

Unmet Parenthood Goals, Health-Related Quality of Life and Apparent Irrationality: Understanding the Value of Treatments for Infertility

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