Estimating the public economic gains in Taiwan from in vitro fertilization (IVF) subsidy changes implemented in 2021.

study questionWhat is the governmental fiscal impact of a new assisted reproduction subsidy scheme based on projected lifetime net taxes attributed to resulting live births in Taiwan? SUMMARY ANSWER: We estimate that the new fertility reimbursement scheme has generated favorable lifetime fiscal gains for the Taiwanese government, resulting in a return on investment (ROI) of NT$5.6 for every NT$1.0 spent based on those families receiving public subsidies for fertility care under the new scheme. WHAT IS KNOWN ALREADY: Globally, there is variation in the amount of public reimbursement for assisted reproduction provided to infertile couples. Cost is an important consideration for many infertile couples that can influence the amount of services provided and the types of services used. STUDY DESIGN, SIZE, DURATION: The analysis is based on the number of live births resulting from those couples receiving public subsidies for assisted reproduction. The cohort is based on those children born between March 2022 and July 2023. PARTICIPANTS/MATERIALS, SETTING,

methodsA lifetime fiscal model was developed to project age-specific lifetime tax revenue and age-dependent benefits likely received from government attributed to the children born. The analysis is based on age-specific projected earnings adjusted for work activity and applied to published income tax burden data, in addition to estimated indirect consumption taxes paid. Furthermore, we estimate the lifetime national insurance contributions per worker, including employer contributions. To account for changes over the modeling period, we increased wages based on historical economic growth, government benefits were increased based on the rate of consumer price inflation rate, and all costs and taxes were discounted at 3.5%. MAIN RESULTS AND THE ROLE OF CHANCE: A child born in Taiwan in 2022 is expected to pay discounted gross tax revenues of NT$7 257 438 and receive NT$5 373 730 in discounted future benefits from the government. Following implementation of the new funding policy, based on the number of resulting births, the cost per live birth is NT$331 918. Applying the cost per live birth, we estimate the discounted net tax revenue to be NT$1 551 789 for each child born from the subsidy. The ROI for the Taiwanese government is estimated at 568% over the lifetime of the IVF-conceived children. LIMITATIONS, REASONS FOR CAUTION: Several assumptions are applied in making long-term financial projections. Should economic conditions change dramatically, this could influence the projections described in our work. WIDER IMPLICATIONS OF THE

findingsThe results suggest the government benefits from public subsidy for fertility services when taking into consideration the long-term work activity of these children and future tax revenue generated for government. The results are broadly applicable to other markets, although variations in wages, lifetime work activity, and taxation rates would influence the conclusions reported here. STUDY FUNDING/COMPETING INTEREST(S): The work was sponsored by the Merck Group in Singapore (funding to N.K. and M.P.C.). The sponsoring organization was given an opportunity to review the final manuscript; however, the authors retained full editorial control over the final published materials. The authors hold no financial interests in the sponsoring company. N.K. and M.P.C. have received consulting fees from Merck and Organon and payment/honoraria from Merck. M.-J.C. received no funding for this work but has received honoraria for lectures from the Taiwanese Society for Reproduction Medicine, Taiwanese Association of Obstetrics and Gynecology, Japanese Society of Obstetrics and Gynecology, The Endocrine Society of the ROC, Merck, Organon, and Ferring; attendance fees for expert meetings from Health Promotion Administration, Ministry of Health and Welfare, Taiwan, and the National Science and Technology Council of Taiwan; and support for attending meetings and/or travel from the National Science and Technology Council of Taiwan and Merck. None of the other authors report any conflicts in relation to this work. TRIAL REGISTRATION NUMBER: N/A.