The economic benefit of implementing assisted reproductive technology within a national health system: insights from the Italian model

Background: Models evaluating both costs and economic benefits of assisted reproductive technology (ART) implementation are lacking. This constitutes a major limitation in the decision-making process of resource allocation. Herein, we aimed to estimate the economic and social impact of female infertility in Italy and examine the benefits generated by investment in ART from a national perspective. Methods: A retrospective cohort study was conducted using the Italian Hospital Discharge Records database to identify women aged 18–50 undergoing ART between 2014 and 2016 in Italy. Patients were followed for up to 36 months after the first ART complete cycle. Hospitalization costs were analyzed nationally, while outpatient care and drug consumption costs were assessed in a sub-analysis using administrative databases from LHU Umbria 2. A fiscal impact model was developed from a governmental perspective, projecting lifetime tax revenues and public expenditures associated with the ART birth cohort, including costs for healthcare, education, pensions, and social transfers. All future values were discounted at 3% in line with Italian economic evaluation guidelines. Results: A total of 33,713 women met the inclusion criteria. During the follow-up, 48.4% achieved pregnancy resulting in childbirth. The average hospital care cost per patient was €5,853, with a projected national expenditure of €337 million for ART management. Younger women (18–33 years) had the highest success rates (61.8%). Assuming 16,300 live births, the model estimated net fiscal benefits of €3.3 billion over the lifetime of these individuals, equivalent to €203,856 per live birth. Conclusion: This study highlights the economic and fiscal benefits of ART, emphasizing the need for policies promoting early access to treatment. ART investment represents a strategic approach to mitigate demographic decline, with each live birth substantially contributing to national fiscal stability.