{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:36:08Z","timestamp":1747186568534,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>From April 2022, the Japanese government funding system for assisted reproductive technology (ART) has shifted from government subsidies to universal health insurance. To date, studies estimating the health care expenditure for ART are scarce. We estimated health care expenditures for ART cycles and compared the proportion of patients' out\u2010of\u2010pocket payment by ovarian stimulation protocols under the Japanese government subsidy system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We linked payment information for government subsidies in Saitama Prefecture during 2016 and 2017 with the Japanese ART registry. Health care expenditures for all treatment cycles in Japan during 2017 among women aged &lt;43\u2009years (<jats:italic>n<\/jats:italic>\u2009=\u2009369\u2009757) were estimated using a generalized linear model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We linked 6269 subsidy applications to the Japanese ART registry. The average treatment fee for a fresh cycle was 376\u2009434 JPY (standard deviation\u2009=\u2009159\u2009581). However, significant variation was observed across ovarian stimulation protocols. The estimated health care expenditure for ART during 2017 was 101\u2009278\u2009629\u2009888 JPY (920\u2009714\u2009817\u2009USD), leading to a 0.24% increase in the national health care expenditure for fiscal year 2017. Fresh cycles accounted for 70% of the expenditure. The proportion of the average patient out\u2010of\u2010pocket payment for one treatment cycle was smaller for natural (0%) and mild ovarian stimulation using clomiphene citrate (4.5%\u201320.7%) than those of conventional stimulation (30.3%\u201332.4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Health insurance coverage for ART would increase national health care expenditure by 0.24%. Under the subsidy system, the proportion of the average patient out\u2010of\u2010pocket payment was smaller for natural and mild ovarian stimulation than conventional stimulations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.15676","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T04:38:51Z","timestamp":1684298331000},"page":"1778-1786","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Model\u2010based estimation of the health care expenditure and out\u2010of\u2010pocket payment for assisted reproductive technology: A retrospective linkage study using the Japanese national <scp>ART<\/scp> registry"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5714","authenticated-orcid":false,"given":"Seung Chik","family":"Jwa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Saitama Medical University  Saitama Japan"},{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rei","family":"Goto","sequence":"additional","affiliation":[{"name":"Graduate School of Business Administration Keio University  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6858-3754","authenticated-orcid":false,"given":"Eri","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Science and Public Health Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4853-9297","authenticated-orcid":false,"given":"Takeshi","family":"Kajihara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Saitama Medical University  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Saitama Medical University  Saitama Japan"},{"name":"Kagawa Nutrition University  Sakado Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12434"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2020.03.007"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-15-2830-9_1"},{"key":"e_1_2_9_5_1","unstructured":"Ministry of Health Labour and Welfare.Summary of vital statistics in 2019. Available from:https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/jinkou\/kakutei19\/dl\/02_kek.pdf. Accessed 8 September 2022 [Japanese]"},{"key":"e_1_2_9_6_1","unstructured":"Ministry of Health Labour and Welfare.Insurance coverage for infertility treatment; 2021. Available from:https:\/\/www.mhlw.go.jp\/content\/12404000\/000718601.pdf. Accessed 8 September 2022 [Japanese]"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12337"},{"key":"e_1_2_9_8_1","unstructured":"Ministry of Health Labour and Welfare.Overview of National Health Care Expenditures in fiscal year 2017. Available from:https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/k\u2010iryohi\/17\/dl\/H29data.pdf. Accessed 8 September 2022 [Japanese]"},{"key":"e_1_2_9_9_1","unstructured":"Ministry of Health Labour and Welfare.Research study on the actual condition of fertility treatment: final report. 2021. Available from:https:\/\/www.mhlw.go.jp\/content\/12404000\/000768684.pdf. Accessed 8 September 2022 [Japanese]"},{"key":"e_1_2_9_10_1","unstructured":"Japan Society of Obstetrics and Gynecology.Assisted reproductive technology Databook 2017. Available from:http:\/\/plaza.umin.ac.jp\/~jsog-art\/2017data_20191015.pdf. Accessed 8 September 2022 [Japanese]"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det386"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/16.2.259"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.04.041"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.03.003"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12397"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040617-013517"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12307"},{"key":"e_1_2_9_18_1","article-title":"Natural cycle in vitro fertilisation (IVF) for subfertile couples","volume":"8","author":"Allersma T","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmaa035"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den435"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2013.10.002"}],"container-title":["Journal of Obstetrics and Gynaecology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.15676","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T13:22:05Z","timestamp":1692278525000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/jog.15676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,16]]},"references-count":20,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1111\/jog.15676"],"URL":"https:\/\/doi.org\/10.1111\/jog.15676","archive":["Portico"],"relation":{},"ISSN":["1341-8076","1447-0756"],"issn-type":[{"type":"print","value":"1341-8076"},{"type":"electronic","value":"1447-0756"}],"subject":[],"published":{"date-parts":[[2023,5,16]]},"assertion":[{"value":"2022-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}