Neumann P J, Gharib S D, Weinstein M C
Project HOPE Center for Health Affairs, Bethesda, Md 20814.
N Engl J Med. 1994 Jul 28;331(4):239-43. doi: 10.1056/NEJM199407283310406.
The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so, to what extent. We investigated the cost of a successful delivery with in vitro fertilization.
We calculated the cost per successful delivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease (who have a better chance of success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success). Information on charges per cycle of in vitro fertilization was obtained from six facilities across the country; delivery rates with this procedure were estimated from the literature.
On average, the cost incurred per successful delivery with in vitro fertilization increases from $66,667 for the first cycle of in vitro fertilization to $114,286 by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequent effort will be successful declines. Sensitivity analyses indicated that the cost per delivery ranges from $44,000 to $211,940. For couples with a better chance of successful in vitro fertilization (i.e., those with a diagnosis of tubal disease), it costs $50,000 per delivery for the first cycle and $72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from $160,000 for the first cycle to $800,000 for the sixth.
The debate about insurance coverage for in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectiveness help elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.
体外受精技术的应用引发了诸多争议，包括谁适合接受该治疗、医疗保险是否应涵盖其费用以及若涵盖，应覆盖到何种程度。我们对体外受精成功分娩的成本进行了调查。
我们计算了接受体外受精的普通夫妇群体以及两个亚组成功分娩（定义为至少有一次活产）的成本：诊断为输卵管疾病的夫妇（成功几率较高），以及女性年龄超过40岁且男性精子数量低的夫妇（成功几率较低）。从全国六个机构获取了每个体外受精周期的收费信息；该治疗的分娩率根据文献估算得出。
平均而言，体外受精成功分娩的成本从第一个周期的66,667美元增加到第六个周期的114,286美元。成本增加是因为随着受精失败的每个周期，后续努力成功的概率会下降。敏感性分析表明，每次分娩的成本在44,000美元至211,940美元之间。对于体外受精成功几率较高的夫妇（即诊断为输卵管疾病的夫妇），第一个周期每次分娩成本为50,000美元，第六个周期为72,727美元。对于女性年龄较大且诊断为男性因素不孕症的夫妇，成本从第一个周期的160,000美元上升到第六个周期的800,000美元。
关于体外受精保险覆盖范围的辩论必须考虑伦理判断和社会价值观。但对成本和成本效益的分析有助于阐明使用体外受精的经济影响，从而为政策讨论提供参考。
