Using conjoint analysis to take account of patient preferences and go beyond health outcomes : an application to in vitro fertilisation

Background The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so, to what extent. We investigated the cost of a successful delivery with in vitro fertilization. Methods We calculated the cost per successful delivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease (who have a better chance of success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success). Information on charges per cycle of in vitro fertilization was obtained from six facilities across the country; delivery rates with this procedure were estimated from the literature. Results On average, the cost incurred per successful delivery with in vitro fertilization increases from $66,667 for the first cycle of in vi...

The Cost of a Successful Delivery with in Vitro Fertilization

This article concerns the first stage of a research and development project that aimed to produce both parent and professional guidelines on the promotion and provision of informed choice for families with deaf children. It begins with a theoretical discussion of the problems associated with the concept of informed choice and deaf child services and then focuses specifically on why a metastudy approach was employed to address both the overcontextualized debate about informed choice when applied to deaf children and the problems associated with its investigation in practice with families and professionals. It presents a detailed analysis of the conceptual relevance of a range of identified studies "outside" the field of deafness. These are ordered according to 2 main conceptual categories and 7 subcategories-(a) the nature of information: "information that is evaluative, not just descriptive"; "the difficulties of information for a purpose"; "the origins and status of information"; and "informed choice and knowledge, not informed choice and information" and (b) parameters and definitions of choice: "informed choice as absolute and relative concept", "preferences and presumptions of rationality", and "informed choice for whom?" Relevant deaf child literature is integrated into the discussion of each conceptual debate in order both to expand and challenge current usage of informed choice as applied to deaf children and families and to delineate possible directions in the planning of the next stage of the main project aimed at producing parent/professional guidelines.

Informed Choice and Deaf Children: Underpinning Concepts and Enduring Challenges

This article assesses the impact of transformations in reproduction upon health, welfare and wider social issues. The article first considers how a growing trend for women to remain childless might more fully be understood within broader constructions of social change and technological transformations of reproduction. Second, the article considers the impact of what is termed a postmodern model of reproduction upon changing health, welfare and broader social needs. The article concludes that although these changes give rise to potentially empowering options, especially for women, significant risks and challenges need to be addressed in order to meet the changing social landscape of the contemporary era.

Contextualizing voluntary childlessness within a postmodern model of reproduction: implications for health and social needs:

During recent years there has been a growth in the use of assisted reproductive techniques (ARTs) across Europe, America and Australia. This has resulted in debates about whether health insurance should cover this procedure. This study used the closed-ended (CE) willingness to pay (WTP) technique to establish the value the infertile place on in vitro fertilization (IVF) treatment in Scotland. The intention is to consider the use of the economic instrument of WTP for informing the debate on the public provision of IVF. Assuming that the value of the service outweighs the cost, public provision should be encouraged. The responses suggested that users of the service have a mean WTP of over £5000 for an attempt at IVF. This compares with an average government expenditure of 7pound;2700. The internal validity of the CE WTP was also shown, with income being positively related to WTP. It is concluded that the CE WTP technique is potentially a useful tool for policy makers in considering the public provision of I...

Should government fund assisted reproductive techniques? A study using willingness to pay

Are in-vitro fertilisation and embryo transfer of benefit to all?

The efficacy, safety, costs, and benefits of in-vitro fertilisation and embryo transfer (IVF/ET) have been reviewed. IVF/ET benefits only a small proportion of infertile women, it is expensive, and has serious health risks. Therefore policies for the management of infertility in which most financial and manpower resources are applied to prevention of infertility must be developed. Health authorities should also require accreditation of IVF/ET programmes, certification of providers, and ongoing monitoring of clinics. Full and accurate information on IVF/ET must also be disseminated, so that individuals seeking treatment for infertility can make the best informed choice about their care and health authorities can decide the place of IVF/ET in their infertility services.

PATRlClA A. St. Clair

Papers

Are in-vitro fertilisation and embryo transfer of benefit to all?

Are In-Vitro Fertilisation and Embryo Transfer of Benefit to All?