Dunn Andrea L, Stafinski Tania, Menon Devidas
Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021, Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2V2, Canada.
Health Policy. 2014 Jun;116(2-3):238-63. doi: 10.1016/j.healthpol.2014.03.006. Epub 2014 Mar 15.
The purpose of this study was to compare existing policies regarding access to 7 assisted reproductive technologies (ARTs) and to examine the effects of these policies on costs, utilization, and health outcomes in 14 countries and 2 Canadian provinces based on publicly available information.
A systematic review of publicly available information from peer-reviewed literature (using biomedical and social science databases) and grey literature (e.g., health ministry websites, health technology assessment agency websites, etc.) was performed.
ARTs services permitted or funded vary across jurisdictions. The goals and eligibility restrictions (e.g., on maternal age, number of embryos transferred, and number of cycles) defined in ARTs policies also vary across jurisdictions. Studies on the impact of such policies have primarily been retrospective and focused on short-term service utilization. Nevertheless, they suggest that the policies have achieved specific outcomes, such as reductions in multiple births and in costs to payers.
Based on the evidence reviewed, policies aimed at reducing public coverage of ARTs or restricting the number of embryos transferred have achieved these goals. However, their effects on maternal and infant health outcomes have not been well explored.
本研究旨在比较有关7种辅助生殖技术（ART）获取的现有政策，并根据公开信息，考察这些政策对14个国家和加拿大2个省份的成本、利用情况及健康结局的影响。
对同行评议文献（使用生物医学和社会科学数据库）及灰色文献（如卫生部网站、卫生技术评估机构网站等）中的公开信息进行系统综述。
ART服务在不同司法管辖区的许可或资助情况各不相同。ART政策中规定的目标和资格限制（如产妇年龄、移植胚胎数量和周期数）在不同司法管辖区也存在差异。关于此类政策影响的研究主要是回顾性的，且集中在短期服务利用方面。然而，这些研究表明，这些政策已取得了特定成果，如多胎妊娠减少和支付方成本降低。
基于所审查的证据，旨在减少ART公共覆盖范围或限制移植胚胎数量的政策已实现了这些目标。然而，它们对母婴健康结局的影响尚未得到充分探讨。
