National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, New South Wales, Australia.
Fertil Steril. 2013 Aug;100(2):319-27. doi: 10.1016/j.fertnstert.2013.06.017.
Alongside the debate around clinical, scientific, and ethical aspects of assisted reproductive technology (ART), there exists a parallel debate around the economics of ART treatment and what is the most appropriate funding framework for providing safe, equitable, and cost-effective treatment. The cost of ART treatment from a patient perspective exhibits striking differences worldwide due to the costliness of underlying health care systems and the level of public and third-party subsidization. These relative cost differences affect not only who can afford to access ART treatment but how ART is practiced in terms of embryo transfer practices; in turn significantly impacting the health outcomes and costs of caring for ART conceived children. Although empirical evidence indicates that ART treatment is "good value money" from a societal and patient perspective, the challenge remains to communicate this to policy makers, primarily because fertility treatments are not easily accommodated by traditional health economic methods. Furthermore, with global demand for ART treatment likely to increase, it is important that future funding decisions are informed by what has been learned about how costs and economic incentives influence equity of access and clinical practice. In this review we provide an international perspective on the costs and consequences of ART and summarize key economic considerations from the perspective of ART patients, providers, and society as a whole in the coming decade.
除了辅助生殖技术（ART）的临床、科学和伦理方面的争论外，还存在着关于 ART 治疗的经济学以及为提供安全、公平和具有成本效益的治疗提供最合适的资金框架的争论。由于基础医疗保健系统的昂贵程度和公共和第三方补贴的水平，从患者角度来看，ART 治疗的成本在全球范围内存在显著差异。这些相对成本差异不仅影响谁有能力获得 ART 治疗，还影响胚胎移植实践中 ART 的实施方式；进而对 ART 受孕儿童的健康结果和护理成本产生重大影响。尽管实证证据表明，从社会和患者的角度来看，ART 治疗“物有所值”，但仍然需要向决策者传达这一点，主要是因为生育治疗不容易被传统的健康经济方法所涵盖。此外，随着全球对 ART 治疗的需求可能增加，重要的是，未来的资金决策要考虑到成本和经济激励如何影响获取途径和临床实践的公平性。在这篇综述中，我们从国际角度探讨了 ART 的成本和后果，并从 ART 患者、提供者和整个社会的角度总结了未来十年的关键经济考虑因素。
