Economic Appraisal of in Vitro Fertilization: Discussion Paper

Introduction As with all new and expensive techniques in medicine the development of in vitro fertilization (IVF) presents the providers of health care with several problems. There is considerable pressure to provide the service from infertile couples, as well as gynaecologists who wish to extend the range of services they provide and who see at first hand the distress caused by infertility. The media know that the happiness of a couple on the birth of their child, conceived with such great difficulty, will be shared by their readers and that the corollary of this shared happiness is a widespread sympathy for couples who are unable to conceive. If the new technique is widely taken up by the private sector, as is the case with IVF, then inequality of distribution becomes a problem. The NHS, whose aim is to provide equity of distribution of services, is faced with the glaring inequality of a service which is available to those who can afford to pay but not to the less well off unless they are lucky enough to live within the catchment area ofone ofthe few NHS units or a unit based in a research-funded University department. In order to make rational decisions about the development of new services information is needed about the demand for those services, the costs and the likely outcome of service provision. The paradox is that such information is not forthcoming until the service is actually provided on a reasonably large scale in an NHS setting. This paper summarizes the work done tow assist Trent Regional Health Authority in deliberations about the funding of IVF. Sheffield, within the Trent Region. This unit is fumded by research money and by patients who can afford to pay a nominal fee.