Methodological Questions of Cost-Effectiveness Calculation of Health Technologies Aiming to Improve Fertility

OBJECTIVES: Even in jurisdictions with well-established health technology assessment (HTA) processes, guidance may be lacking on cost-effectiveness calculation of health technologies aiming to improve fertility. This is because these interventions are not aiming to directly improve the life expectancy or quality of life of patients but to increase the likelihood of childbearing.

METHODS: A scoping review was conducted to identify the relevant systematic literature reviews (SLR) on the health economic evaluations and models related to assisted reproductive technologies via PubMed and Embase in June 2024. In addition, multiple European pharmacoeconomic guidelines were reviewed, and experts were involved in multiple rounds of internal discussions to identify the most scientifically sound ways of assessing the cost-effectiveness of fertility interventions.

RESULTS: As the result of the scoping review, 671 articles and 13 HTA agencies’ websites were reviewed. If the local pharmacoeconomic guideline allows its use, the most straightforward way can be a cost-effectiveness analysis (CEA), where the outcomes are expressed in natural units, in this case the expected number of children being born after the application of health technology and its comparator. Cost-utility analyses (CUA) may consider the sum of expected QALYs of the child during their lifetime. Even if it is not the main goal of such interventions, the changes in the utility of parents can also be considered. Additionally, through a cost-benefit analysis (CBA), the predicted future earnings of the child during the child’s lifetime can be assessed. Though all four approaches have methodological limitations, conducting all of them and presenting these together allows decision makers to get a full picture on multiple aspects relevant for fertility interventions.

CONCLUSIONS: It is often unclear what is the most adequate methodology for calculating cost-effectiveness of health technologies aiming to improve fertility. We propose a comprehensive approach, by conducting multiple analyses, considering various aspects.