The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate.

OBJECTIVE To examine the costs and outcomes of infertility-related services in Massachusetts during a time of expanded use of assisted reproductive technology (ART). DESIGN Cost data were obtained from the Massachusetts Department of Insurance Rate-Setting Commission and 9 large group insurance plans for the period 1986-1993. Utilization and success rates of ART were examined, and the cost per live delivery with the use of ART in 1993 was estimated. SETTING The state of Massachusetts, in which access to infertility-related services has been mandated by law since 1989. PATIENT(S) The study population consisted of 8 large health maintenance organization plans and the Blue Cross/Blue Shield indemnity plan. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Per capita infertility-related expenditures, infertility-related expenditures as a percentage of total expenditures, live deliveries per initiated ART cycle, and cost per live delivery. RESULT(S) Expenditures for infertility services increased at a rate similar to or slower than inflation during the years 1988-1992. Increases were slowest in health maintenance organizations, probably as a result of provider arrangements. Infertility services accounted for 0.41% of total expenditures within the indemnity plan in 1993 (approximately $1.71 per contract-month). Examination of ART utilization showed no evidence of overutilization by patients with a low chance of success. The cost per live delivery with the use of ART in 1993 was $59,484. CONCLUSION(S) Mandated infertility coverage was associated with increased use of ART but not with excessive increases in consumer cost for infertility insurance coverage.