Hum. Reprod. Advance Access originally published online on July 22, 2009
Human Reproduction 2009 24(11):2796-2800; doi:10.1093/humrep/dep260
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The impact of introducing patient co-payments in Germany on the use of IVF and ICSI: a price-elasticity of demand assessment
1 Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands 2 Global Market Access Solutions Sàrl, Ch. De Penguey 6B.22, St Prex 1162, Switzerland 3 Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany 4 Academic Unit of Reproductive & Developmental Medicine, University of Sheffield, Sheffield, UK
5 Correspondence address. E-mail: mark{at}gmasoln.com
BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany.
METHODS: Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from ‘no fees’ to 
1500–2000 by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology.
RESULTS: The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of –0.41 and –0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be –0.36. The cross-price elasticity for clomifene was close to zero (–0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred.
CONCLUSIONS: We report price elasticities for IVF and ICSI of –0.41 and –0.34 after introducing a 1500–2000 co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change.
Key words: price-elasticity/cross-price elasticity/co-payment/in-vitro fertilization/fertility treatments
Submitted on March 19, 2009; resubmitted on June 18, 2009; accepted on June 25, 2009.