Li Chaofan, Cong Hongbin, Jan Stephen, Si Lei, Geng Ling, Li Shunping
Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University; NHC Key Lab of Health Economics and Policy Research (Shandong University); Center for Health Management and Policy Research, Shandong University (Shandong Provincial Key New Think Tank); Center for Health Preference Research, Shandong University, Jinan, Shandong Province, 250012, China.
State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong Province, 250012, China.
Health Policy Plan. 2025 Jul 17. doi: 10.1093/heapol/czaf045.
Infertility, a widely prevalent condition globally, incurs high economic burdens. Assisted reproductive technologies (ARTs) are effective treatments, but public health financing in low- and middle-income countries (LMICs) rarely covers ART services. In China, where birth rates are declining, willingness to pay (WTP) can inform insurance reimbursement policies by reducing out-of-pocket expenses. However, there is no consensus on WTP thresholds for assessing the cost-effectiveness of fertility treatments in LMICs. This study aimed to assess WTP for ART among individuals with infertility in China. Data were obtained from a cross-sectional survey conducted at five hospitals across different geographical and socioeconomic regions in China. Individuals with infertility were recruited using a quota sampling method. A contingent valuation method was employed, with three hypothetical WTP scenarios developed to present detailed information on the success rates, costs, and the treatment processes of in-vitro fertilization (IVF), artificial insemination (AI), and preimplantation genetic testing (PGT). A total of 570 individuals with infertility participated in the survey (94.4% female; mean [SD] age: 33.0 [4.7] years). The sampled respondents were willing to pay RMB 30,163 ($4259, 95% CI: RMB 29,650-30,675) for IVF, RMB 6046 ($854, 95% CI: RMB 5987-6106) for AI, and RMB 47,234 ($6669, 95% CI: RMB 46,435-48,033) for PGT. These WTPs were equivalent to 0.34, 0.07, and 0.53 times the GDP per capita in China, respectively. Older age and male-factor or unexplained infertility were significantly associated with lower WTP (P<0.05), while higher education and patient-physician communication about costs were positively associated with WTP (P<0.05). These findings suggest that public health insurance schemes should establish appropriate cost-effectiveness thresholds and reimbursement ceilings for ART to improve affordability and access. Incorporating patient-physician communication about cost into clinical practice may facilitate shared decision-making and potentially increase patients' perceived value of ART.
不孕症是一种在全球广泛流行的疾病，会带来高昂的经济负担。辅助生殖技术（ART）是有效的治疗方法，但低收入和中等收入国家（LMICs）的公共卫生筹资很少涵盖ART服务。在中国，出生率正在下降，支付意愿（WTP）可以通过减少自付费用来为保险报销政策提供参考。然而，对于评估LMICs中生育治疗成本效益的WTP阈值尚无共识。本研究旨在评估中国不孕症患者对ART的WTP。数据来自在中国不同地理和社会经济区域的五家医院进行的横断面调查。采用配额抽样方法招募不孕症患者。采用了条件估值法，设计了三种假设的WTP情景，以提供关于体外受精（IVF）、人工授精（AI）和植入前基因检测（PGT）的成功率、成本和治疗过程的详细信息。共有570名不孕症患者参与了调查（94.4%为女性；平均[标准差]年龄：33.0[4.7]岁）。抽样受访者愿意为IVF支付30163元人民币（4259美元，95%CI：29650-30675元人民币），为AI支付6046元人民币（854美元，95%CI：5987-6106元人民币），为PGT支付47234元人民币（6669美元，95%CI：46435-48033元人民币）。这些WTP分别相当于中国人均GDP的0.34倍、0.07倍和0.53倍。年龄较大以及男性因素或不明原因的不孕症与较低的WTP显著相关（P<0.05），而较高的教育水平以及患者与医生关于成本的沟通与WTP呈正相关（P<0.05）。这些发现表明，公共健康保险计划应建立适当的成本效益阈值和ART报销上限，以提高可承受性和可及性。将患者与医生关于成本的沟通纳入临床实践可能有助于共同决策，并有可能提高患者对ART的感知价值。
