COST OF ASSISTED REPRODUCTIVE TECHNOLOGIES FOR A HEALTH MAINTENANCE ORGANIZATION

OBJECTIVE: To calculate the cost of assisted reproductive technologies (ART) for a health maintenance organization (HMO), assess factors tha t contribute to the cost per delivery and to analyze how utilization r ates can be controlled by the use of clinical criteria. STUDY DESIGN: Pregnancy outcome and a cost analysis of all ART cycles at an HMO in a state with mandated coverage for these procedures was performed. All patients (n=148) undergoing ART cycles insured by the HMO performed at one in vitro fertilization (IVF) center during 1990-1995 were studied . RESULTS: ART cycle outcomes and a cost analysis, including global cy cle and cancellation charges, medication costs, obstetric costs and ne onatal care costs, were assessed. ART cycles (n = 375) included IVF (n = 278), gamete intrafallopian transfer (n=46), cryopreserved embryo t ransfer (ET) (n=42), zygote intrafallopian transfer/tubal embryo trans fer (n=7) and donor oocyte (n=2). Pregnancy outcome with IVF was 18.3% deliveries per retrieval, for gamete intrafallopian transfer 27.8% de liveries per retrieval and for frozen ET 19% per procedure. Overall, 6 2/148 (41.9%) of the patients delivered. There were 35 singletons, 22 twin sets and 5 triplet sets. This resulted in an average cycle cost p er delivery of $36,417. The mean obstetric and neonatal charges were $ 9,329 for a singleton delivery, $20,318 for twins and $153,335 for tri plets. If these charges are expressed in terms of the number of infant s born, a twin pregnancy would cost $10,159 per infant and a triplet p regnancy, $51,112. The ART cycle cost per HMO plan member was $2.49 pe r annum. Our IVF utilization was 295 cycles per million population. CO NCLUSION: An HMO can control the cost of ART services by establishing preauthorization clinical criteria. Our utilization rates might be use d as a benchmark for other insurers considering ART coverage. The cost of ART ($2.49 per annum) would be only a small fraction of the typica l annual insurance premium.