Table 3 Financial expenses and cost-effectiveness after the inclusion of ART in MI.

Index		Current number of infertile couples		New infertile couples per year
Index		11.792 million	4.102 million	1.867 million	1.189 million
IVF	Complete cycles (million)	23.747	8.261	3.760	2.394
	Live births (million)	9.593	3.337	1.519	0.967
	Live infants (million)	12.030	4.185	1.905	1.213
Current cost	According to live birth (billion ¥)	642.780	223.599	101.770	64.812
	According to complete cycle (billion ¥)	567.575	197.438	89.863	57.229
	Average of the above two (billion ¥)	605.178	210.519	95.816	61.021
Expenses after inclusion in MI	Cost after MI negotiation (billion ¥)	302.589	105.259	47.908	30.510
	MI payment (billion ¥)	207.878	72.313	32.913	20.961
	Personal payment (billion ¥)	94.710	32.946	14.995	9.550
Cost-effectiveness	New live infants due to MI (million)	9.624	3.348	1.524	0.970
	LEV per complete cycle (million ¥)	3.174	3.174	3.174	3.174
	Net tax contribution (billion ¥)	2707.094	941.698	428.608	272.959
	Financial input–output ratio	13.022	13.022	13.022	13.022

(1) ART—Assisted reproductive technology, MI—medical insurance, LEV—lifetime economic value. (2) Assuming that all infertile couples receive ART, and the losers enter the next initiated cycle (up to 4 times); In this case, the cumulative live birth rate is 81.36%, the average number of complete cycle is 2.014, and LBR per complete cycle is 0.404. (3) Live infants = Live births * (1 + Multiple birth rate 0.254). (4) LEV per complete cycle = Per capita GDP 80, 976 ¥ * Life expectancy 77.3 years * Live infants per complete cycle (0.404 * 1.254); Net tax contribution = Total tax amount (Per capita tax 12, 235 ¥ * Life expectancy 77.3 years)—Educational financial investment (Per capita education funds 15, 280 ¥ * Per capita education years 10.9 years)—Medical financial investment (Per capita medical cost 1, 760 ¥ * Life expectancy 77.3 years)—Pension financial investment (Per capita pension cost 20, 496 ¥ * Years of pension 17.3 years)—MI payment on ART; Financial input–output ratio = Net tax contribution / MI payment; The data are the values in 2021 and are derived from the official government website. (5) Assuming that after ART is included, the total cost will be reduced by 50% and the fund will pay 68.7%. (6) Assuming that at present 20% of infertility couples receive ART. (7) The cost-effectiveness analysis does not consider the impact of changes in per capita GDP, life expectancy, years of education and inflation.

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