The Association Between Annual Household Income and Total Monthly Amount of Out-of-Pocket Medical Expenses Patients Are Willing to Pay Among Patients of Infertility in Japan: A Cross-Sectional Patient Survey
Author(s)
Sooyeol Lim, MBA, MSc, Michael LoPresti, MSc, Akihiro Matsunaga, BSc, Shoichi Inoue, BSc.
INTAGE Healthcare, Tokyo, Japan.
INTAGE Healthcare, Tokyo, Japan.
OBJECTIVES: To boost fertility rates, Japan began covering assisted reproductive technology (ART) under its universal health insurance program since April 2022. However, earlier research by Maeda et al. (2022) showed out-of-pocket payment to be a key determinant in patients’ decision to undergo ART treatment. We examine the association between annual household income (AHI) and total monthly out-of-pocket medical expenses patients are willing to pay (OOP) among infertility patients using real-world cross-sectional survey data.
METHODS: Real-world data from the 2023 Patient Mindscape® survey was used. Patient Mindscape® is a Japanese nationwide patient-reported outcomes survey conducted annually among 500,000+ patients for 80 conditions. The sample included married female patients aged 25-42 who reported suffering from infertility only within the past one year. AHI categories were classified into 3 groups: low (< 5 million JPY), medium (5 - < 10 million JPY), high (≥ 10 million JPY). OOP categories were coded as a binary variable for ≥ 10,000 JPY per month. Binary variables for age 40-42 with restricted reimbursement, presence of child in cohabitation, employment were also considered. Chi-square tests were used to examine the association between AHI and demographic factors. Logistic regression models were used to examine the association between AHI and OOP. A p value < 0.05 was considered statistically significant.
RESULTS: 458 infertility patients were analyzed. There were statistically significant associations between AHI and employment as well as OOP. 27.7%, 40.9%, and 57.1% of patients in the low, middle, and high AHI groups had OOP ≥ 10,000 JPY per month. Logistic regression showed statistically significant effect of AHI on OOP, whereas other covariates were not statistically significant.
CONCLUSIONS: AHI was the most important factor in determining the level of OOP. Policy initiatives should take into consideration the strength of the association between AHI and OOP to promote further use of the new reimbursement program.
METHODS: Real-world data from the 2023 Patient Mindscape® survey was used. Patient Mindscape® is a Japanese nationwide patient-reported outcomes survey conducted annually among 500,000+ patients for 80 conditions. The sample included married female patients aged 25-42 who reported suffering from infertility only within the past one year. AHI categories were classified into 3 groups: low (< 5 million JPY), medium (5 - < 10 million JPY), high (≥ 10 million JPY). OOP categories were coded as a binary variable for ≥ 10,000 JPY per month. Binary variables for age 40-42 with restricted reimbursement, presence of child in cohabitation, employment were also considered. Chi-square tests were used to examine the association between AHI and demographic factors. Logistic regression models were used to examine the association between AHI and OOP. A p value < 0.05 was considered statistically significant.
RESULTS: 458 infertility patients were analyzed. There were statistically significant associations between AHI and employment as well as OOP. 27.7%, 40.9%, and 57.1% of patients in the low, middle, and high AHI groups had OOP ≥ 10,000 JPY per month. Logistic regression showed statistically significant effect of AHI on OOP, whereas other covariates were not statistically significant.
CONCLUSIONS: AHI was the most important factor in determining the level of OOP. Policy initiatives should take into consideration the strength of the association between AHI and OOP to promote further use of the new reimbursement program.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD284
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Reproductive & Sexual Health