Health system level microcosting of infertility management in India: a retrospective cross-sectional study
Akshita Vikani, Prerana Patil, Deepshikha Sharma, Oshima Sachin, Biju Soman, Bhavani Shankara Bagepally, Renu Tanwar, Vanita Suri, Radha V, Anitha M, Ramesh P, Deepti Shrivastava, Sukhpreet Patel, Shankar Prinja, Beena JoshiObjectives
This study estimates the cost of managing infertility, including intrauterine insemination (IUI) from health system perspective in India.
Design
This was a retrospective cross-sectional microcosting study using mixed approach. Unit costs were estimated at the cost-centre level based on average resource utilisation and aggregated by facility type and cause of infertility. The cost data was collected for the year 2022–2023 and adjusted for inflation in 2025.
Setting
The study was conducted at five healthcare facilities providing infertility services, of which three were public and two were private hospitals situated in different parts of country.
Participants
The cost data was collected from different departments of hospitals. To determine the service utilisation, 100 infertility patients were enrolled at each hospital. Patients undergoing infertility treatment (including IUI) for five selected causes of infertility and willing to participate in the study were included.
Primary and secondary outcome measures
The cost of providing infertility treatment for 1 year was the primary outcome measure. The share of different cost-components in the total cost was the secondary outcome measure.
Results
The one-year health system cost of infertility management ranged from INR 5515 (USD 63) to INR 15 139 (USD 173). Median costs were generally higher in public hospitals compared to private hospitals. Outpatient consultations contributed about two-thirds of total costs. The mean cost of one IUI cycle ranged from INR 8272 (USD 94) to INR 8887 (USD 101).
Conclusions
This first-of-its-kind study provides robust evidence on the health system cost of infertility management in India. The findings highlight significant cost variations by infertility cause and facility type, underscoring the need for inclusion of infertility services, particularly IUI, within public health financing packages. These results offer a foundation for future cost-effectiveness analyses and policy decisions related to infertility treatment in India.