Stijn Hoorens

The costs and consequences of assisted reproductive technology: an economic perspective

BACKGROUND Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. METHODS A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. RESULTS The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. CONCLUSIONS The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

Assessing long-run economic benefits attributed to an IVF-conceived singleton based on projected lifetime net tax contributions in the UK †

BACKGROUND Over the past decade, demand for fertility treatments has increased as a result of delaying time to first pregnancy and growing awareness and acceptance of available treatment options. Despite increasing demand, health authorities often view infertility as a low health priority and consequently limit access to treatments by rationing and limiting funds. METHODS To assess the long-term economic benefits attributed to in vitro fertilization (IVF)-conceived children, we developed a health investment model to evaluate whether state-funded IVF programmes in the UK represent sound fiscal policies. Based on the average investment cost to conceive an IVF singleton, we describe the present value of net taxes derived from gross taxes paid minus direct government transfers received (e.g. education, health, pension) over the lifetime of the child. To establish the present value of investing in IVF, we have discounted all costs from benefits (i.e. lifetime taxes paid) using UK Treasury department rates based on a singleton delivery with similar characteristics for education, earnings, health and life expectancy to a naturally conceived child. RESULTS The lifetime discounted value of net taxes from an IVF-conceived child with mother aged 35 is pound 109,939 compared with pound 122,127 for a naturally conceived child. The lifetime undiscounted net tax contribution for the IVF-conceived child and naturally conceived child are pound 603,000 and pound 616,000, respectively. CONCLUSIONS An investment of pound 12,931 to achieve an IVF singleton is actually worth 8.5-times this amount to the UK Treasury in discounted future tax revenue. The analysis underscores that costs to the health sector are actually investments when a broader government perspective is considered over a longer period of time.

Should ART Be Part of a Population Policy Mix? A Preliminary Assessment of the Demographic and Economic Impact of Assisted Reproductive Technologies

Visit RAND at www.rand.org Explore RAND Europe View document details For More Information THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

Use of childcare services in the EU Member States and progress towards the Barcelona targets

Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND Web site is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

Gender equality in the workforce: Reconciling work, private and family life in Europe.

Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND Web site is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

Using Bibliometrics to Support the Procurement of NIHR Biomedical Research Centres in England

In 2006 the English Department of Health launched a programme with £450m for the funding of around 10 biomedical research centres over a five-year period, to be within leading clinical and university partnerships, able to demonstrate international excellence and reflect a range of clinical areas. The bespoke process to procure the biomedical research centres resulted in relatively low transaction costs, compared to more traditional routes into funding research centres, and is an example of the use of metrics that could inform the on-going debate in the UK regarding future research assessment exercises. Copyright , Beech Tree Publishing.

Mid-Term Assessment of the EU Drugs Strategy 2013-2020 and Final Evaluation of the Action Plan on Drugs 2013-2016: Final report

: The aim of the EU Drugs Strategy 2013-2020 is to contribute to a reduction in drug demand and drug supply within the EU. The Strategy has so far been implemented by an Action Plan covering the period 2013-2016. This article sets out the findings of an evaluation that assesses the degree of implementation of the Strategy and the Action Plan in terms of outputs and, where possible, impacts. It looks at the extent to which the objectives of the Strategy have been achieved. The evaluation aims to provide evidence to support the European Commissions decision about whether to propose a new Action Plan for the period 2017-2020 and, if so, what changes would be needed compared to the current plan. Through applying a mixed-methods approach, the evaluation examined the effectiveness, efficiency, relevance and coherence of the actions undertaken on the basis of the EU Drugs Strategy and the Action Plan, as well as their EU added value. The evaluation makes 20 recommendations, addressed to the European Commission, Member States, the European Council and other stakeholders. The key recommendation for the Commission is that a new Action Plan should be implemented for the period 2017-2020. This should be an updated version of the current Action Plan, rather than taking a new approach or introducing more new actions.

The role of the 'dark web' in the trade of illicit drugs

The Internet has fundamentally changed ways of doing business, including the operations and activities of illegal markets. There are now around 50 online marketplaces on the ‘dark web’ that trade illegal drugs, novel psychoactive substances (NPS), prescription drugs and other – often illegal – goods and services. These so-called cryptomarkets are accessible with a normal Internet connection, but require special anonymising software to access.

Gender equality in the workforce

Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND Web site is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

Money in—babies out: assessing the long-term economic impact of IVF-conceived children

We welcome Ms Smajdor’s critique into our investigations of expected future tax gains to the state from children conceived by in vitro fertilisation (IVF).1 To better inform the JME readership, we wish to correct some misinterpretations of our research by Smajdor, and to highlight some weaknesses of current IVF funding policies. Our investigation sought to establish the long-term net tax contribution from an IVF-conceived child, assuming that the child was average in every respect (eg, life expectancy, earnings, health, education).2 We conducted this analysis on the basis that IVF, and other assisted reproductive treatments, are unique among all medical interventions—unique in the sense that their success leads to the creation of human life; a life that would not have existed had the technology not been available and accessible to couples willing to undergo treatment. Hence, this method provides us with an opportunity to explore lost tax revenue to the state resulting from children that have not been born due to limited public access to IVF treatments currently observed in the UK and many other countries. In our investigations, the costs of IVF were treated as an investment in human capital with future long-term cost and revenue implications for the state. Our evaluation ignored the many humanistic reasons for offering IVF treatment to infertile couples and concentrated solely on the possible economic benefits.3 The perspective of the analysis was that of the state; hence …