Cost-effectiveness of assisted reproductive technologies in Saudi Arabia: Comparing in vitro fertilization with intrauterine insemination

Objectives: The aim of this study was to compare the cost-effectiveness of in vitro fertilization and intrauterine insemination for the management of unexplained, mild male and mild female factor infertility in Saudi Arabia. Methods: A cost-effectiveness analysis from a societal perspective was conducted for couples seeking assisted reproductive technology services between January and December 2016 in one of the largest private hospitals in Saudi Arabia. Activity-Based Costing and Step-Down Costing methodologies with expert interviews were used to compute the costs of in vitro fertilization and intrauterine insemination. A total of 710 assisted reproductive technology procedures were observed by the embryologist in charge. The costs calculated included direct and indirect costs. A cost-effectiveness analysis and a Monte Carlo simulation probabilistic sensitivity analysis were conducted. Results: The average cost per in vitro fertilization and intrauterine insemination cycle was SR 27,360 (range: SR 19,541–29,618) and SR 10,143 (range: SR 7568–11,976), respectively, and the live birth rate per initiated in vitro fertilization and intrauterine insemination cycle was 20.7% and 7.9%, respectively, resulting in an average cost per live birth per in vitro fertilization and intrauterine insemination treatment cycle of SR 132,174 (95% confidence interval: 120,802–143,546) and SR 128,392 (95% confidence interval: 124,468–132,316), respectively. The incremental cost-effectiveness ratio was SR 134,508 per extra live birth implicit in a decision to treat with in vitro fertilization. Probabilistic sensitivity analysis confirms the robustness of the cost-effectiveness results. Conclusion: This study found that from a societal perspective, one in vitro fertilization treatment cycle was more cost-effective than intrauterine insemination in Saudi Arabia.