Markets, money and multiple births: A review of international data to identify trends in consumer and provider behaviour 1 1 Georgina CHAMBERS , Elizabeth SULLIVAN 1 Perinatal and Reproductive Epidemiology Research Unit (PRERU), University of New South Wales, Sydney, Australia. Abstract Aim: To compare regulatory, clinical and economic aspects of ART in developed countries, thereby identifying potential trends in utilisation, success rates and multiple delivery rates. Method: A comparative policy and economic analysis of selected developed countries with differing regulatory and financing arrangements for ART. Results: Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system, rather than the regulatory or funding environment. The cost (AUD 2006) of an IVF cycle ranged from $16,627 in the US to $5,257 in Japan. The cost per livebirth was highest in the US and UK ($54,656 and $53,636) and lowest in Scandinavia and Japan ($32,672 and $31,485). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the US to 6% in Australia. Australia and Scandinavia were the only country/region surveyed to reach t levels of utilisation approximating demand. Multiple delivery rates were highes in countries with the lowest levels of consumer affordability. Preliminary results indicate that over $15 million is saved per year in birth-admission costs alone from the voluntary reduction in ART multiple births in Australia over the last 5 years. Conclusion: ART is expensive from a patient’s perspective but not from a societal perspective. Only countries with funding arrangements which minimise user charges can expect to optimise demand while voluntarily lowering multiple delivery rates. Funding mechanisms should maximise ing efficiency and equity of access while minimis the potential harm from multiple births.