National Infertility Group Report January 2013

Appendix B Economic modelling

All modelling will be available to view, from 10 May 2013, at: http://www.scotland.gov.uk/infertility

Summary costs for all Scotland	Column reference	Cost	Increase/Decrease from A. current cost	%	Increase/Decrease from B. expected cost	%
A. Current cost per annum of NHS IVF based on the number of cycles of NHS funded IVF performed during 2011/12	12	£4.92
B. Expected cost if all eligible patients referred per annum were able to have NHS funded IVF (i.e. no waiting list)	13	£10.07
Single scenarios
Cost of NHS IVF if age criteria extended to <40	15	£10.16	£5.23	106%	£0.09	1%
Costs if criteria restricted for BMI and Smoking (adjusted)	16	£7.27	£2.35	48%	-£2.79	-28%
Costs if criteria restricted for BMI and Smoking (alternative adjustment for stopping smoking/losing weight)	17	£7.78	£2.85	58%	-£2.29	-23%
Costs if criteria allowed for 2 cycles	18	£10.11	£5.19	105%	£0.05	0%
Costs if criteria allowed for 3 cycles	19	£13.08	£8.15	166%	£3.01	30%
Costs if waiting list reduced to 12 months	20	£11.07	£6.15	125%	£1.01	10%
Costs if criteria adjusted for no genetic child	21	£11.78	£6.85	139%	£1.71	17%
Costs if consistent parameters across centres	22	£10.44	£5.52	112%	£0.38	4%
Combination scenarios
Base ('B.' plus increase of 10% for reduced wait)		£11.07
Scenario 1 (BMI/Smoking*, 2 cycles, reduced wait)	23	£8.58	£3.65	74%	-£1.49	-15%
Age, BMI/Smoking, 2 cycles	24	£7.87	£2.94	60%	-£2.20	-22%
Age, BMI/Smoking, 3 cycles	25	£10.17	£5.25	107%	£0.10	1%
Age, BMI/Smoking, 2 cycles, reduced wait	26	£8.65	£3.73	76%	-£1.41	-14%
Age, BMI/Smoking, 3 cycles, reduced wait	27	£11.19	£6.26	127%	£1.12	11%
Age, BMI/Smoking, No genetic child, 2 cycles	28	£9.20	£4.28	87%	-£0.86	-9%
Age, BMI/Smoking, No genetic child, 3 cycles	29	£11.90	£6.97	142%	£1.83	18%
Age, BMI/Smoking, No genetic child, reduced wait, 2 cycles	30	£10.13	£5.20	106%	£0.06	1%
Age, BMI/Smoking, No genetic child, reduced wait, 3 cycles	31	£13.09	£8.16	166%	£3.02	30%
Scenario 2 (BMI/Smoking*, age, no genetic child, reduced wait, 3 cycles)	32	£12.92	£7.99	162%	£2.85	28%

Baseline inputs	1	2	3	4	5	6	7	8	9	10
	Population (mid year est 2011)	Rate of couples presenting at GP surgery per 1,000	Number of couples expected to present at GP surgery	Number expected to be referred on for 2ary or 3ary treatment (71%)	Number expected to have IVF (patients) (53%)	% NHS	Number expected to have NHS IVF treatment (patients)	Average number of cycles per patient	Number expected to have NHS IVF treatment (cycles)	Actual number (2011/2012) having NHS IVF (cycles)
Glasgow
Glasgow	1,210,254	1.51	1823	1294	687	64%	440	1.70	749	388
Lanarkshire	563,185	1.47	829	588	312	64%	200	1.70	341	185
Ayrshire & Arran	366,890	1.58	580	412	219	64%	140	1.70	238	118
Dumfries & Galloway	148,060	0.84	124	88	47	64%	30	1.70	51	33
Edinburgh
Lothian	848,727	1.60	1358	964	512	43%	220	1.60	352	195
Borders	113,150	1.65	187	133	70	43%	30	1.60	48	33
Aberdeen
Grampian	555,280	1.13	625	444	236	51%	120	2.20	265	120
Highland	311,960	1.00	312	221	118	51%	60	2.20	132	70
Orkney	20,160	2.32	47	33	18	51%	9	2.20	20	12
Shetland	22,500	1.85	42	30	16	51%	8	2.20	18	10
Dundee
Fife	367,292	2.20	808	574	305	46%	140	1.50	211	55
Forth Valley	295,541	2.53	748	531	282	46%	130	1.50	195	54
Tayside	405,721	1.56	633	449	239	46%	110	1.50	165	85
Western Isles	26,080	1.67	44	31	16	46%	8	1.50	11	10
Scotland	5,254,800		8,158	5,792	3,077		1,645		2,796	1,368
Centre totals
Glasgow	2,288,389		3,356	2,383	1,266		810		1,379	724
Edinburgh	961,877		1,545	1,097	583		250		401	228
Aberdeen	909,900		1,025	728	387		197		434	212
Dundee	1,094,634		2,232	1,585	842		387		582	204
Scotland	5,254,800		8,158	5,792	3,077		1,645		2,796	1,368

Costs	11	12	13	14	15	16	16*	17	18	19	20	21
	Average cost of IVF cycle (£)	Baseline cost of NHS IVF (£M)	Costs of NHS IVF if all eligible couples treated (basline criteria) (£M)	Increase in demand for NHS IVF if age criteria extended to <40 years	Cost of NHS IVF if age criteria extended to <40	Costs if criteria restricted for BMI and smoking (allowing for stopping/losing weight)	Costs if criteria restricted for BMI and smoking (no allowance for stopping/losing)	Costs if cycles set to max. of 2 (Actual ave 1.69-1.72))	Costs if cycles set to max. of 3 (Actual ave 2.17-2.24)	Cost if NHS demand increases by 10% due to reduced waiting list	Cost if NHS demand increases by 17% due to one partner has no genetic child	Cost if parameters across centres were consistent
		(Costs of actual cycles of NHS IVF, as at end 2011)	(Costs of expected cycles of NHS IVF)
Glasgow
Glasgow	3,600	£1.40	£2.70	0%	£2.70	£1.81	£2.00	£2.71	£3.50	£2.97	£3.16	£2.41
Lanarkshire	3,600	£0.67	£1.23	0%	£1.23	£0.82	£0.91	£1.23	£1.59	£1.35	£1.43	£1.12
Ayrshire & Arran	3,600	£0.42	£0.86	0%	£0.86	£0.58	£0.64	£0.86	£1.11	£0.94	£1.00	£0.73
Dumfries & Galloway	3,600	£0.12	£0.18	0%	£0.18	£0.12	£0.14	£0.18	£0.24	£0.20	£0.22	£0.29
Edinburgh
Lothian	3,600	£0.70	£1.27	0%	£1.27	£1.27	£1.27	£1.34	£1.72	£1.40	£1.48	£1.69
Borders	3,600	£0.12	£0.17	0%	£0.17	£0.17	£0.17	£0.18	£0.24	£0.19	£0.20	£0.22
Aberdeen
Grampian	3,600	£0.43	£0.95	0%	£0.95	£0.58	£0.75	£0.73	£0.94	£1.05	£1.11	£1.10
Highland	3,600	£0.25	£0.48	0%	£0.48	£0.29	£0.38	£0.37	£0.47	£0.52	£0.56	£0.62
Orkney	3,600	£0.04	£0.07	0%	£0.07	£0.04	£0.06	£0.05	£0.07	£0.08	£0.08	£0.04
Shetland	3,600	£0.04	£0.06	0%	£0.06	£0.04	£0.05	£0.05	£0.06	£0.07	£0.07	£0.04
Dundee
Fife	3,600	£0.20	£0.76	12%	£0.85	£0.56	£0.52	£0.87	£1.13	£0.83	£0.89	£0.73
Forth Valley	3,600	£0.19	£0.70	0%	£0.70	£0.52	£0.48	£0.80	£1.05	£0.77	£0.82	£0.59
Tayside	3,600	£0.31	£0.59	0%	£0.59	£0.44	£0.40	£0.68	£0.89	£0.65	£0.69	£0.81
Western Isles	3,600	£0.04	£0.04	0%	£0.04	£0.03	£0.03	£0.05	£0.06	£0.04	£0.05	£0.05
Scotland		£4.92	£10.07		£10.16	£7.27	£7.78	£10.11	£13.08	£11.07	£11.78	£10.44

	23	24	25	26	27	28	29	30	31	32
	Scenario 1 BMI/smoking (non-adjusted), 2 cycles	Combination of age, BMI/smoking, 2 cycles	Combination of age, BMI/smoking, 3 cycles	Combination of age, BMI/smoking, 2 cycles, reduced wait	Combination of age, BMI/smoking, 3 cycles, reduced wait	Combination of age, BMI/smoking, genetic child, 2 cycles	Combination of age, BMI/smoking, genetic child, 3 cycles	Combination of age, BMI/smoking, genetic child, reduced wait, 2 cycles	Combination of age, BMI/smoking, genetic child, reduced wait, 3 cycles	Combination of age, BMI/smoking*, genetic child, reduced wait, 3 cycles
Glasgow
Glasgow	£2.20	£2.00	£2.59	£2.20	£2.85	£2.34	£3.03	£2.58	£3.34	£3.29
Lanarkshire	£1.00	£0.91	£1.18	£1.00	£1.30	£1.07	£1.38	£1.17	£1.52	£1.50
Ayrshire & Arran	£0.70	£0.64	£0.82	£0.70	£0.91	£0.75	£0.96	£0.82	£1.06	£1.05
Dumfries & Galloway	£0.15	£0.14	£0.18	£0.15	£0.19	£0.16	£0.21	£0.18	£0.23	£0.22
Edinburgh
Lothian	£1.48	£1.34	£1.72	£1.48	£1.89	£1.57	£2.01	£1.73	£2.22	£2.19
Borders	£0.20	£0.18	£0.24	£0.20	£0.26	£0.22	£0.28	£0.24	£0.30	£0.30
Aberdeen
Grampian	£0.64	£0.58	£0.75	£0.64	£0.82	£0.68	£0.87	£0.75	£0.96	£0.95
Highland	£0.32	£0.29	£0.37	£0.32	£0.41	£0.34	£0.44	£0.37	£0.48	£0.47
Orkney	£0.05	£0.04	£0.06	£0.05	£0.06	£0.05	£0.07	£0.06	£0.07	£0.07
Shetland	£0.04	£0.04	£0.05	£0.04	£0.05	£0.05	£0.06	£0.05	£0.06	£0.06
Dundee
Fife	£0.65	£0.66	£0.86	£0.73	£0.95	£0.77	£1.01	£0.85	£1.11	£1.09
Forth Valley	£0.60	£0.55	£0.71	£0.60	£0.78	£0.64	£0.83	£0.70	£0.92	£0.90
Tayside	£0.51	£0.46	£0.60	£0.51	£0.66	£0.54	£0.70	£0.60	£0.78	£0.77
Western Isles	£0.04	£0.03	£0.04	£0.04	£0.05	£0.04	£0.05	£0.04	£0.05	£0.05
Scotland	£8.58	£7.87	£10.17	£8.65	£11.19	£9.20	£11.90	£10.13	£13.09	£12.92
Centre totals
Glasgow	£4.06	£3.69	£4.77	£4.06	£5.25	£4.31	£5.58	£4.75	£6.14	£6.06
Edinburgh	£1.68	£1.53	£1.96	£1.68	£2.15	£1.79	£2.29	£1.96	£2.52	£2.49
Aberdeen	£1.05	£0.95	£1.22	£1.05	£1.34	£1.11	£1.43	£1.22	£1.57	£1.55
Dundee	£1.80	£1.70	£2.22	£1.87	£2.44	£1.99	£2.59	£2.19	£2.85	£2.82
Scotland	£8.58	£7.87	£10.17	£8.65	£11.19	£9.20	£11.90	£10.13	£13.09	£12.92

Notes

Figures are subject to change as centres are still verifying parameters.

Column ref

1 Population of NHS Board, Mid-year estimate 2011 from NRS http://www.gro-scotland.gov.uk/statistics/theme/population/estimates/mid-year/index.html

2 Rate of couples presenting at GP surgery per 1,000 population Rates are based on centres knowledge of the numbers of patients being referred for IVF

3 Number of couples expected to present at GP surgery Calculated from columns 1 and 2.

4 Number expected to be referred on for 2ary or 3ary treatment (71%) Figure of 71% taken from the Merck Serono model.

5 Number expected to have IVF (patients) (53%) Figures are based on a decision tree process used in the Merck Serono model which calculates the numbers expected to be referred through 2ary to 3ary and then onto IVF and also those expected to be referred straight to 3ary and then on for IVF.

6% NHS This is the percentage of the population of the NHS Board that have NHS funded IVF. The denominator is all women in the NHS Board that have IVF (including those going to private clinics and those that self fund).

7 Number expected to have NHS IVF treatment (patients) Calculated from columns 5 and 6.

8 Average number of cycles per patient This is calculated from data collected from the boards at the end of 2011 on the numbers of patients having treatment and the numbers of cycles they received.

9 Number expected to have NHS IVF treatment (cycles) This represents all women who would be expected to be referred for NHS IVF annually if there were no restriction on waiting time. Calculated from columns 7 and 8.

10 Actual number (2011/2012) having NHS IVF (cycles) This is the actual number of cycles performed during the 2011/12 period, and has been provided by the centres.

11 Average Cost of IVF cycle (£) The average cost of a cycle of IVF has been calculated using recent data from NHS Boards for total costs for NHS IVF and the number of NHS cycles performed. The figure has been compared to costs used in the NICE consultation and is comparable to the cost stated for one fresh cycle plus a proportion of patients (25%) also receiving a frozen embryo transfer. (http://www.nice.org.uk/nicemedia/live/12157/59278/59278.pdf) As this figure is based on an average cost it may be that it is not reflective of the costs of incremental cycles.

12 Baseline Cost of NHS IVF (£M) This represents the current cost of NHS IVF and is calculated from the number of NHS cycles performed in 2011/12 and the average cost of a cycle (columns 10 and 11).

13 Costs of NHS IVF if all eligible couples treated (baseline criteria) (£M) This represents the cost if all eligible couples who are referred for NHS funded IVF (under current access criteria) were to be treated, assuming no waiting list. Calculated from columns 9 and 11.

14 Increase in demand for NHS IVF if age criteria extended to <40 years Many centres are already treating women up to the age of 40 years, however, due to the length of the waiting list, some women do not get treatment as they reach the age cut off whilst on the waiting list. It is difficult to measure precisely the impact on numbers for each centre and therefore approximate increases have been estimated based on the current length of the waiting list. Boards whose age cut off is currently <38 years (NHS Fife) are assumed to experience a 12% increase in NHS demand once the age range is extended to <40years.

15 Cost of NHS IVF if age criteria extended to <40 Calculated based on columns 9, 11 and 14.

16 Costs if criteria restricted for BMI and smoking (allowing for stopping/losing weight) Data on numbers of women having IVF who smoke or are outwith the BMI range 18-29.9 have been obtained from Aberdeen and Dundee centres. Edinburgh no longer treat smokers or those outwith the BMI range. Data for Glasgow have been estimated using the Aberdeen and Dundee data. Assumptions have been made regarding the numbers of patients that would give up smoking or lose/gain weight in order to meet the eligibility criteria based on current experience in Edinburgh. The resulting decrease in NHS demand has therefore been estimated to be -26% (Dundee), -39% (Aberdeen) and -33% (Glasgow).

16* Costs if criteria restricted for BMI and smoking (adjusted allowance for stopping/losing) Adjusted according to revised information from centres resulting in decreases in NHS demand of -32% (Dundee), -21% (Aberdeen), -26% (Glasgow).

17 Costs if cycles set to max. of 2 (Actual ave 1.69-1.72) Current data from the centres shows that the averge number of cycles a patient receives varies from 1.5 to 2.2. This scenario looks at the expected costs if all centres offered 2 cycles. A number of women, dependent on the success rates of treatment, will only require 1 cycle and therefore the actual average number of cycles will be less than 2. Information from the Merck Serono model and verified, where possible, by centres shows that the actual average number of cycles received if patients were eligible for a maximum of 2 would be: 1.71 (Glasgow), 1.69 (Edinburgh), 1.70 (Aberdeen), 1.72 (Dundee). The analysis is based on a simplified version of the types of embryo transfers that take place and the success rates for live births according to the data that were available at the time. The reality is more complex involving different combinations of embryo transfers and frozen embryo transfers.

18 Costs if cycles set to max. of 3 (Actual ave 2.17-2.24) Similar to the situation described above, this scenario looks at the expected costs if all centres offered a maximum of 3 cycles. The actual average number of cycles received if patients were eligible for 3 would be: 2.21 (Glasgow), 2.17 (Edinburgh), 2.18 (Aberdeen), 2.24 (Dundee).

19 Cost if NHS demand increases by 10% due to reduced waiting list It is assumed that if the waiting list were to be reduced to 12 months there would be greater demand for NHS funded IVF. This increase in demand is assumed to be 10%.

20 Cost if NHS demand increases by 17% due to one partner has no genetic child It is assumed that if the eligibility criteria were extended to allow for one partner having no genetic child the demand for NHS funded IVF would increase. This increase in demand is assumed to be 17%.

21 Cost if parameters across centres were consistent Where possible the model parameters (such as referral rates, the proportion of NHS/Self-Funded/Private cycles and the average number of cycles per patient) have been amended to reflect different practice across centres. This column, however, assumes that these rates are the same across boards/centres so that the impact of the differences can be guaged. Referral rates are assumed to be 1.55 per 1,000. The proportion of NHS funded cycles is assumed to be 56%. The average number of cycles is 1.69.

22 Base Scenario This assumes that all women who are referred for IVF (under current eligibility criteria) are treated (ie same as 'B. Expected cost' but allowing for the fact that there will be a 10% increase in demand due to the reduced wait).

23 Scenario 1 Restrictive criteria ie. only BMI/smoking (no adjustment) criteria is assumed with 2 cycles.

24 Combination of age, BMI/smoking, 2 cycles This column provides the expected cost if a combination of eligibility criteria were adopted. Age (column 15), BMI/smoking (column 16) and max. of 2 cycles (column 17) are combined.

25 Combination of age, BMI/smoking, 3 cycles Age (column 15), BMI/smoking (column 16) and max. of 3 cycles (column 18) are combined.

26 Combination of age, BMI/smoking, 2 cycles, reduced wait Age (column 15), BMI/smoking (column 16) and max. of 2 cycles (column 17) and increase in demand (10%) if wait reduced to 12 months are combined.

27 Combination of age, BMI/smoking, 3 cycles, reduced wait Age (column 15), BMI/smoking (column 16) and max. of 3 cycles (column 17) and increase in demand (10%) if wait reduced to 12 months are combined.

28 Combination of age, BMI/smoking, Genetic Child, 2 cycles Age (column 15), BMI/smoking (column 16), increase in demand (17%) if one partner has no genetic child, and max. of 2 cycles (column 17) are combined. Combination of age, BMI/smoking, genetic child, 3 cycles

29 Age (column 15), BMI/smoking (column 16), increase in demand (17%) if one partner has no genetic child, and max. of 3 cycles (column 18) are combined. Combination of age, BMI/smoking, genetic child, reduced wait, 2 cycles

30 Age (column 15), BMI/smoking (column 16), increase in demand (17%) if one partner has no genetic child, increase in demand (10%) if wait reduced to 12 months, and maximum of 2 cycles (column 17) are combined.

31 Combination of age, BMI/smoking, genetic child, reduced wait, 3 cycles Age (column 15), BMI/smoking (column 16), increase in demand (17%) if one partner has no genetic child, increase in demand (10%) if wait reduced to 12 months, and maximum of 3 cycles (column 18) are combined.

32 Scenario 2 Combination of age, BMI/smoking* (non-adjusted), genetic child, reduced wait, 3 cycles