The economic burden of infertility treatment and distribution of expenditures overtime in France: a self-controlled pre-post study

BACKGROUND: Recent cost studies related to infertility treatment have focused on assisted reproductive technologies. None has examined lower-intensity infertility treatments or analyzed the distribution of infertility treatment expenditures over time. The Purpose of the study was to analyse the size and distribution of infertility treatment expenditures over time, and estimate the economic burden of infertility treatment per 10,000 women aged 18 - 50 in France from a societal perspective. METHODS: We used French National individual medico-administrative database to conduct a self-controlled before-after analytic cohort analysis with 556 incidental women treated for infertility in 2014 matched with 9,903 controls using the exact matching method. Infertility-associated expenditures per woman and per 10,000 women over the 3.5-year follow-up period derived as a difference-in-differences. RESULTS: The average infertility related expenditure per woman is estimated at 6,996 (95% CI: 5,755-8,237) euros, the economic burden for 10,000 women at 70.0 million (IC95%: 57.6-82.4) euros. The infertility related expenditures increased from 235 (IC95%: 98-373) euros in semester 0, i.e. before treatment, to 1,509 (IC95%: 1,277-1,741) euros in semester 1, mainly due to ovulation stimulation treatment (47% of expenditure), to reach a plateau in semesters 2 (1,416 (IC95%: 1,161-1,670)) and 3 (1,319 (IC95%: 943-1,694)), where the share of expenses is mainly related to hospitalizations for assisted reproductive technologies (44% of expenditure), and then decrease until semester 6 (577 (IC95%: 316-839) euros). CONCLUSION: This study informs public policy about the economic burden of infertility estimated at 70.0 million (IC95%: 57.6-82.4) euros for 10,000 women aged between 18 and 50. It also highlights the importance of the share of drugs in infertility treatment expenditures. If nothing is done, the increasing use of infertility treatment will lead to increased expenditure. Prevention campaigns against the preventable causes of infertility should be promoted to limit the use of infertility treatments and related costs.