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NEW YORK (Reuters Health) - In Australia, a boom in vitro fertilization (IVF) and other assisted reproduction techniques prompted a heated debate in 2006 on whether government should subsidize the treatments.
In a government-funded study just published in the journal Human Reproduction, researchers from Australia explored policy options to control costs.
Their research suggests that cost per live birth from IVF increases with maternal age and number of treatments and shows that maternal age has the greater effect.
"This evidence," Alison Griffiths from The University of Sydney in Camperdown and colleagues say, "may help decision-makers target the use of IVF services conditional on societal willingness to pay for live births and equity considerations."
Despite the findings that poorer outcomes occurred in older women and with great numbers of IVF attempts, the Australian government ultimately decided to continue to subsidize the procedures.
With relatively unrestricted access to fertility services and limits on medical expenses borne by patients, Australian government expenditures on assisted reproduction more than doubled from 2000 to 2005 -- from AU$66.3 million to $156.1 million (US$207.4 million).
From 2002 to 2003, there was a 16 percent increase in the use of assisted production technology, or ART, services among Australians compared with an increase of 13 percent among Europeans and 6.5 percent among Americans.
Griffiths and colleagues found that the price per baby ranged from AU$27,373 to $31,986 (US$36,365 to $42,493) for women 30 to 33 years old on their first and third IVF treatments to AU$130,951 to $187,515 (US$173,968 to $249,114) for 42 to 45-year-old women on their first and second IVF attempts.
"This information is useful for clinicians and consumers to discuss the relative effectiveness and cost-effectiveness of ART by age and treatment cycle number," Sarah J. Lord, a University of Sydney epidemiologist and co-author on the study noted in an email to Reuters Health. However, the current study was not designed to guide clinical practice, she emphasized.
IVF expert Dr. Edmond Confino, of Northwestern University's Feinberg School of Medicine, who was not involved in the research, said the Australian study again confirms what has been found in other research over the past 20 years - namely, that the cost to produce a baby with IVF increases with a woman's age.
Confino expressed concerns that research emphasizing poor outcomes in older women could boomerang and lead to discrimination against women. He fears that such findings could lead policy makers to cap the age for women eligible for ART.
"In other words, they will say it is not economical to provide you with IVF coverage if you are say 38 and above because that's the age when it becomes very expensive. That's a discriminatory practice, equivalent of telling you you're not going to get a heart repair procedure," Confino noted in a telephone interview with Reuters Health.
Currently in the U.S., only 15 states have laws requiring insurance coverage for infertility treatment. Confino said many of the laws have loopholes that exempt insurance from covering IVF. For example, he said some states exempt self-insured companies and small employers from the laws. Also, he said some insurers limit the number of IVF attempts.
Griffiths and her colleagues say their findings wouldn't automatically lead to ART restrictions in Australia. "It is notable," they wrote, "that Australia currently supports a policy to encourage population growth, which includes a baby bonus payment to couples with newborn infants. Unrestricted funding of fertility services may therefore be consistent with a high value per live birth."
A high incremental cost per live birth may also be considered acceptable in older age groups if the potential population of interest is comparatively small compared with younger groups, the researchers add. In Australia, they explain, only 9 percent of women starting IVF in 2002 were aged 42 to 45, "which means that the total financial impact of IVF for this age group would be expected to be substantially lower than for younger women."
If government started restricting age on IVF, some couples may opt to have "more embryos transferred per cycle earlier, leading to higher costs and potentially poorer outcomes due to multiple births," they point out.
SOURCE: Human Reproduction, January 26, 2010