Willingness to pay for assisted reproductive technologies among individuals with infertility in China.

Abstract

Infertility, a widely prevalent condition globally, incurs high economic burdens. Assisted reproductive technologies (ARTs) are effective treatments, but public health financing in low- and middle-income countries (LMICs) rarely covers ART services. In China, where birth rates are declining, willingness to pay (WTP) can inform insurance reimbursement policies by reducing out-of-pocket expenses. However, there is no consensus on WTP thresholds for assessing the cost-effectiveness of fertility treatments in LMICs. This study aimed to assess WTP for ART among individuals with infertility in China. Data were obtained from a cross-sectional survey conducted at five hospitals across different geographical and socioeconomic regions in China. Individuals with infertility were recruited using a quota sampling method. A contingent valuation method was employed, with three hypothetical WTP scenarios developed to present detailed information on the success rates, costs, and the treatment processes of in-vitro fertilization (IVF), artificial insemination (AI), and preimplantation genetic testing (PGT). A total of 570 individuals with infertility participated in the survey (94.4% female; mean [SD] age: 33.0 [4.7] years). The sampled respondents were willing to pay RMB 30,163 ($4259, 95% CI: RMB 29,650-30,675) for IVF, RMB 6046 ($854, 95% CI: RMB 5987-6106) for AI, and RMB 47,234 ($6669, 95% CI: RMB 46,435-48,033) for PGT. These WTPs were equivalent to 0.34, 0.07, and 0.53 times the GDP per capita in China, respectively. Older age and male-factor or unexplained infertility were significantly associated with lower WTP (P<0.05), while higher education and patient-physician communication about costs were positively associated with WTP (P<0.05). These findings suggest that public health insurance schemes should establish appropriate cost-effectiveness thresholds and reimbursement ceilings for ART to improve affordability and access. Incorporating patient-physician communication about cost into clinical practice may facilitate shared decision-making and potentially increase patients' perceived value of ART.