Evidence on long-term economic impact of assisted reproductive technology: a systematic review

Abstract

To summarize evidence on long-term economic impact of assisted reproductive technology (ART). Systematic review of studies evaluating long-term (i.e., lifetime) economic impact of ART. Two independent reviewers conducted searches on PUBMED, MEDLINE, SCOPUS and through cross-referencing. Keywords are “ART”, “IVF”, "IUI", “infertility care”, “infertility treatment”, “economic impact”, “lifetime”, “lifetime productivity”, “generational accounting”, “net present value”, and “net tax”. We included peer-reviewed articles in English from database inception to 30 April 2018. 9 of 3576 identified papers were selected. All of them assessed long-term economic impact by calculation of net present value (NPV) based on a generational accounting (GA) model. We calculated return on investment (ROI) by dividing discounted lifetime NPV by the cost of in vitro fertilization (IVF) or intrauterine insemination (IUI). NPV was reported for 11 countries; Sweden (2008), the United States (2008), the United Kingdom (2008), Denmark (2011), Brazil (2011), Greece (2013), the Netherlands (2014), Ukraine (2015), Belarus (2015), Kazakhstan (2015) and Spain (2016). Long-term economic impact was reported for IVF-conceived children in all 11 countries and for IUI-conceived children in 1 country (Spain). The ART-conceived children had positive NPV (i.e., positive ROI) in all countries except for the Netherlands. IVF-conceived children: Discounted lifetime NPV of IVF-conceived children ranged from -119,734 USD (the Netherlands) to 215,450 USD (Denmark). Median discounted NPV was 61,429 USD (Brazil). Cost of IVF per live birth ranged from 4,147 USD (Kazakhstan) to 27,552 USD (Sweden) with the median cost of 16,159 USD (the Netherlands). ROI ranged from -740.98% (the Netherlands) to 1,598.95% (Spain) with the median ROI at 353.66% (Greece). IUI-conceived children: Discounted lifetime NPV of IUI-conceived children was 84,470 USD. Cost of IUI per live birth was 4,558 USD and the ROI was 1,853.23%. Influential factors: Influential factors based on sensitivity analyses were economic growth rate, healthcare expenditure growth rate and discount rate but not cost of IVF or IUI. Correlational analyses between NPV of IVF-conceived children and gross domestic product (GDP) per capita indicated almost no correlation in developed countries, r = -.05 but a highly correlated relationship in developing countries, r = .77. All studies used GA to calculate NPV; however, there were variations in model structures and input parameters. None of the studies included broader economic benefits that individuals could contribute to their national economy beyond tax payment. Evidence on long-term economic impact of ART showed positive NPV and ROI of approximately 354%. Therefore, ART can be perceived as a good investment from a societal perspective. However, there are limitations to the methods used to evaluate long-term economic impact of ART.