Table 5.
Possible implications of cost-equivalence for IVF policy
| Pure cost-equivalence | Cost-effectiveness equivalence (or CETE) | ||
|---|---|---|---|
| 1. | Equal access to IVF (regardless of age) | ✓ | |
| 2. | Prognosis-adjustment. The quantity of publicly funded IVF could be linked more directly to the probability of live birth, and take into account a wider range of factors predicting probability of live birth | ✓ | |
| 3. | Co-payment. Patients would pay a variable co-payment to reflect the chance of live birth. Those with a low chance of live birth would pay a larger proportion of the cost of providing IVF | ✓ | |
| 4. | Discounted IVF. If cheaper forms of IVF become available, women with lower chance of live birth would be able to access CEE equivalent IVF by using cheaper techniques (e.g. [4]) | ✓ | |
| 5. | Permit publicly funded IVF using donor eggs for older women* | ✓ | ✓ |
* The chance of live birth using donor eggs appears to be related to donor age, not maternal age [30, 42]. If the justification for denying IVF to older women is on the basis of reduced chance of live birth, it would be potentially cost-equivalent to provide access to IVF using donor eggs (once the cost of oocyte donation is factored in)