PIH89 - Evaluation of Patient and Financial Outcomes Associated With Advanced Infertility Treatment Options

Abstract

A model was designed to evaluate infertility treatment protocols and examines the medical and pharmacy budget impact from a patient and health plan perspective. An Excel-based platform (Microsoft Excel 2010) was designed to model the cost and expected number of pregnancies associated with the following advanced infertility treatments: natural cycle intrauterine insemination (IUI), IUI with clomiphene citrate (IUI-C), IUI with gonadotropins (IUI-G), in vitro fertilization (IVF) and IVF with intracytoplasmic injection (IVF+ICSI). The model is designed to customize inputs within key parameters including population, treatment strategies and health plan coverage. Standard fertility treatment strategy can choose to enter one of five standard first line treatment pathways including IUI, IUI-C, IUI-G, IVF or IVF+ICSI. Fast track fertility treatment strategy does not include the use of IUI-G. Health plan coverage allows end user to input drug coverage (yes/no, copayment per cycle and patient coinsurance) and procedure coverage (yes/no, number of cycles covered, copayment, number of covered doctor visits per cycle and patient coinsurance). Default model population of women initiating fertility treatment is 1,555. The total cost to the health plan per year (health plan perspective) for the standard fertility treatment strategy is about 50M USD compared to the fast track fertility treatment strategy at about 41M USD for a net budget impact of 9M USD. The average cost per patient per year (patient perspective) for the standard fertility treatment strategy is approximately 4,800 USD compared to the fast track fertility treatment strategy at an estimated 4,200 USD for a net budget impact of approximately 600 USD. Results vary upon user inputs. An Excel-based model was developed to assist managed care organizations and employers with the development of an optimal fertility benefit design. The model serves as an educational tool to evaluate various fertility benefit designs in terms of patient and financial outcomes.