Health state utilities for infertility and subfertility

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13/05/2019 12:00 am

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Health state utility values allow for comparison of treatments across different diseases. Utility values for fertility-impaired health states are currently unavailable. Such values are necessary in order to determine the relative costs-effectiveness of fertility treatments.

World-wide, about 15 % of the people experience difficulties with getting pregnant. Several treatments are available to help people who have fertility problems. These treatments are usually too expensive for people to pay for themselves. In the Netherlands, these treatments are therefore often paid for by the health insurers. Nevertheless, it is regularly questioned whether such treatments should be paid from national health care budgets, since people may not directly consider infertility to be a condition for which society should pay the treatment.

This study was conducted to determine whether the general population thinks fertility treatments should be paid for by general means. It was also investigated how much people thought their life would be impacted if they wanted to have children, but were not able to.

Several persons (767) representing the Dutch adult general population were asked about their views on having trouble conceiving. They were asked to participate via an online questionnaire.

The results of this study showed that most persons in the Netherlands are in favour of paying for fertility treatments through the mandatory national Dutch basic health insurance package. About 10% of the people thought this should not be the case. In general, the expected impact of having fertility problems was quite high. To illustrate, this impact was comparable to having migraine attacks twice a week.


This study aimed to determine utility weights for infertile and subfertile health states. In addition, it explored the Dutch general population’s opinions regarding the inclusion of infertility treatments in the Dutch health insurers’ basic benefit package. An online questionnaire was designed to determine the health-related quality of life values of six fertility-impaired health states. The study population consisted of a representative sample of the Dutch adult population. Respondents were asked to evaluate the health states through direct health valuation methods, i.e. the Visual Analogue Scale (VAS) and the Time Trade-Off (TTO) method. In addition, respondents were asked about their opinions regarding reimbursement of fertility-related treatments.


The respondents’ (n = 767) VAS scores ranged from 0.640 to 0.796. TTO utility values ranged from 0.792 to 0.868. Primary infertility and subfertility was valued lower than secondary infertility and subfertility. In total, 92% of the respondents stated that fertility treatments should be fully or partially reimbursed by the health insurance basic benefit package.


Having fertility problems results in substantial disutilities according to the viewpoint of the Dutch general population. The results make it possible to compare the value for money of infertility treatment to that of treatments in other disease areas. There is strong support among the general population for reimbursing fertility treatments through the Dutch basic benefit package.

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