Disparities in infertility workup costs across the United States

Abstract

Objective: To investigate cost disparities of infertility diagnostic tests across the United States. Design: Cross-sectional study analyzing costs for recommended infertility diagnostic tests, including hormone tests (follicle stimulating hormone, luteinizing hormone, estradiol, and progesterone), semen analysis, transvaginal ultrasound, and hysterosalpingogram. Data were sourced from consumer cost claims repositories for five most populous cities per state, categorized into four regions (Midwest, South, West, and Northeast) as per US Census Bureau classifications. Descriptive statistics and analysis of variance with Tukey's post hoc tests evaluated cost variations across states and regions. Setting: Not applicable. Patient(s): No individual subject data. Exposure: Not applicable. Main Outcome Measure(s): Average costs for infertility diagnostic tests by states/regions, correlated with median household income, race, poverty, uninsured rate, and insurance mandates. Result(s): Alaska had highest total cost at $2,986, with Oregon the lowest at $835. Costs for all tests, except follicle stimulating hormone, varied significantly across states. Regional variations were noted, with luteinizing hormone, estradiol, transvaginal ultrasound, and hysterosalpingogram showing significant differences. Total workup costs varied by region, with Midwest having the highest average at $1,651, positively correlated with median household income, followed by Northeast, West, and South. States with insurance mandates for fertility coverage had lower uninsured rates. No correlation was found between state insurance mandates and costs. Conclusion(s): The study highlights significant regional cost disparities in infertility care, emphasizing complexities of access and affordability in the United States. Further research is needed to assess the out-of-pocket financial burden on patients and identify strategies to reduce these costs.