Estimating the Fiscal Value of Children Conceived from Assisted Reproduction Technology in Australia Applying a Public Economic Perspective

<b>Background:</b> Public funding for assisted reproduction varies across countries, which can influence the numbers of infertile couples treated annually, and consequently the numbers of children born each year from this technology. As infertility is a medical condition treated within the healthcare system, it must compete against all other medical interventions for funding. This raises questions about how to evaluate a technology that gives rise to human life compared with other healthcare interventions that reduce morbidity and mortality. <b>Objective:</b> To evaluate annual public spending on assisted reproduction technology (ART) in Australia to determine the likely fiscal impact for government over the projected lifetime of an ART-conceived birth cohort. <b>Methods:</b> A public economic framework was used to evaluate the number of children born from ART procedures performed in Australia in 2021 based on projected future lifetime tax contributions and public benefits received. We leveraged data from the Survey of Income and Housing conducted by the Australian Bureau of Statistics and imputations from tax-transfer microsimulations over the lifetime of the cohort estimating cumulative net-taxes. Public spending per pupil for education and lifetime health costs (in Australian dollars) were included in the benefits estimates. <b>Results:</b> We estimated lifetime gross taxes per individual of A <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>841</mml:mn> <mml:mrow><mml:mo> </mml:mo></mml:mrow> <mml:mn>631</mml:mn> <mml:mo>,</mml:mo> <mml:mi>c</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>s</mml:mi> <mml:mi>i</mml:mi> <mml:mi>s</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>n</mml:mi> <mml:mi>g</mml:mi> <mml:mi>o</mml:mi> <mml:mi>f</mml:mi> <mml:mi>A</mml:mi></mml:math> 580 182 in direct taxation of earnings and A <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>261</mml:mn> <mml:mrow><mml:mo> </mml:mo></mml:mrow> <mml:mn>448</mml:mn> <mml:mi>i</mml:mi> <mml:mi>n</mml:mi> <mml:mi>c</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>s</mml:mi> <mml:mi>u</mml:mi> <mml:mi>m</mml:mi> <mml:mi>p</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>a</mml:mi> <mml:mi>x</mml:mi> <mml:mi>e</mml:mi> <mml:mi>s</mml:mi> <mml:mo>.</mml:mo> <mml:mi>A</mml:mi> <mml:mi>f</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>d</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>u</mml:mi> <mml:mi>c</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>n</mml:mi> <mml:mi>g</mml:mi> <mml:mi>l</mml:mi> <mml:mi>i</mml:mi> <mml:mi>f</mml:mi> <mml:mi>e</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>m</mml:mi> <mml:mi>e</mml:mi> <mml:mi>t</mml:mi> <mml:mi>r</mml:mi> <mml:mi>a</mml:mi> <mml:mi>n</mml:mi> <mml:mi>s</mml:mi> <mml:mi>f</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>s</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>c</mml:mi> <mml:mi>e</mml:mi> <mml:mi>i</mml:mi> <mml:mi>v</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>a</mml:mi> <mml:mi>n</mml:mi> <mml:mi>d</mml:mi> <mml:mi>A</mml:mi> <mml:mi>R</mml:mi> <mml:mi>T</mml:mi> <mml:mi>t</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>a</mml:mi> <mml:mi>t</mml:mi> <mml:mi>m</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>c</mml:mi> <mml:mi>o</mml:mi> <mml:mi>s</mml:mi> <mml:mi>t</mml:mi> <mml:mi>s</mml:mi> <mml:mo>,</mml:mo> <mml:mi>a</mml:mi> <mml:mi>n</mml:mi> <mml:mi>A</mml:mi> <mml:mi>R</mml:mi> <mml:mi>T</mml:mi> <mml:mo>-</mml:mo> <mml:mi>c</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>c</mml:mi> <mml:mi>e</mml:mi> <mml:mi>i</mml:mi> <mml:mi>v</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>c</mml:mi> <mml:mi>h</mml:mi> <mml:mi>i</mml:mi> <mml:mi>l</mml:mi> <mml:mi>d</mml:mi> <mml:mi>w</mml:mi> <mml:mi>a</mml:mi> <mml:mi>s</mml:mi> <mml:mi>p</mml:mi> <mml:mi>r</mml:mi> <mml:mi>o</mml:mi> <mml:mi>j</mml:mi> <mml:mi>e</mml:mi> <mml:mi>c</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>t</mml:mi> <mml:mi>o</mml:mi> <mml:mi>g</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>a</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>A</mml:mi></mml:math> 70 688 in discounted lifetime net tax revenue. Based on average government spend per child, a lifetime fiscal benefit-cost ratio of 2.68 was observed. Based on the 2021 ART treatment cohort, the government was projected to net A$1.29 billion in future taxes over the lifetime of the 18 364 children born. <b>Conclusion:</b> A positive net fiscal gain was achieved from current government spending on ART. We observed that every A <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>1</mml:mn> <mml:mi>s</mml:mi> <mml:mi>p</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>a</mml:mi> <mml:mi>s</mml:mi> <mml:mi>s</mml:mi> <mml:mi>i</mml:mi> <mml:mi>s</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>p</mml:mi> <mml:mi>r</mml:mi> <mml:mi>o</mml:mi> <mml:mi>d</mml:mi> <mml:mi>u</mml:mi> <mml:mi>c</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>y</mml:mi> <mml:mi>i</mml:mi> <mml:mi>e</mml:mi> <mml:mi>l</mml:mi> <mml:mi>d</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>A</mml:mi></mml:math> 2.68 in future discounted net tax revenue. These findings were sensitive to economic conditions such as future wage growth and inflation.