Assisted fertilization, the alarm of President Cecos Allegra

“Difficult times” are announced for couples who want to turn to assisted reproduction. Because “if the proposed rates come into force, neither public nor accredited private companies will be able to offer the service”. “The inclusion of assisted procreation in Lea will thus be nullified and couples wishing to have offspring will still be forced to turn to the Italian or international private market”. This is the alarm raised by prof. Adolfo Allegra, the President of Cecos Italia, the National Association of Assisted Reproduction Centers, who comments “with concern” the “decree scheme concerning the definition of the rates of specialist outpatient and prosthetic assistance drawn up by the Commission Essential levels of assistance at the Ministry of Health “. Cecos speaks of “incomprehensible and surreal hypotheses of rates of Medically Assisted Procreation services” and reiterates “the risks that would arise from the possible entry into force of the Dpcm”. “It is first of all important to underline that the services will be rendered by companies under public and private law, whose financial balance is an indispensable prerequisite of” good service “and that therefore the aforementioned companies should always be able to work with a rate recognition in any case not lower than breakeven point – Allegra explains to Adnkronos – The draft Dpcm object of this document, transmitted by the Presidency of the Council of Ministers to the Conference of the Regions with a note of 29 December 2021, follows, after 5 years, the DPCM 12 January 2017 published on the Guri of 18 March 2017, a document that defined the new LEAs to be included in the tariff nomenclator “. “As far as Pma is concerned, the overall valorisation of a standard homologous in vitro fertilization cycle (sum of the tariff codes of the different phases of the cycle), by the standing commission, is established in the draft at 1,290 euros”, he continues. ” As regards a cycle of assisted fertilization with the donation of frozen oocytes, the value established in the draft is € 1,173.70 (no mention is made of the procurement of oocytes!) And as regards an assisted fertilization cycle in vitro with donation of spermatozoa, the value is € 1,593.05 (here too no mention is made of the supply of spermatozoa!) – continues Prof. Allegra – In the context of the document, however, three of the four “brenchmark regions” (Lombardy, Veneto, Emilia Romagna and Tuscany) which already provide services and which are taken as reference regions, all define an enhancement of the PMA cycle that is higher, and sometimes far superior, to that lla established by the draft. Wanting to go into detail: Lombardia euro 4,698.45 (2017); Emilia Romagna 1,660.48 (2018); Toscana 1826 (2019) “.” Furthermore, the cost analysis criteria used to establish the different tariffs of the different codes, the sum of which defines the overall quantum mentioned, have not been disclosed in any way. Furthermore, many passages of the individual techniques have not been taken into consideration in any way and many new techniques have not even been considered – adds the President of Cecos – It therefore seems only right for us to bring to the attention of public opinion that, immediately after the publication in the Guri of the Presidential Decree of 12 January 2017, a Sub Area PMA chaired by Prof. Carlo Foresta, was established within the Health Commission of the Hospital Assistance Area of ​​the Conference of Regions (coordinated by Dr. Adriano Marcolongo) prestigious assisted procreation experts were involved with the task of defining a draft of the nomenclator tariffs for all the different codes of the different steps of the different techniques “.” The Sub Area began its work on March 16, 2017 and concluded them in date 28 September 2017 with a final document – says Allegra – During the months of work, the Sub Area carried out a painstaking analysis of the costs of individual stages of the individual PMA techniques taking into consideration all the general and specific cost items, down to the last penny (from the cost of the identification bracelet to the cost of ISO certification) “. The Sub Area, at the conclusion of the works,” produced and delivered to the Technical Coordinator of the Hospital Assistance Area a document voted unanimously that defined the different overall rates of the costs of the different techniques “, says Allegra. “Specifically, the total rate for a standard homologous in vitro fertilization cycle was calculated by the Sub Area Pma in Euro 2,318 – he continues – The rates for a heterologous cycle with egg donation and a heterologous cycle in vitro with sperm donation (also here by removing the start-up phase of the procedure) were respectively valued by the PMA Sub Area in Euro 4,752.64 and Euro 2,498.28 “. “With regard to heterologous techniques, the PMA Sub Area has also taken into consideration the procurement costs of gametes from foreign banks (in Italy, currently, it is not possible to offer any compensation to any donors / donors and therefore there are no our country voluntary donors and there are very few voluntary sperm donors). In fact, even the latest Report presented by the Minister of Health to Parliament on MAP (of October 2021 and referred to the activity of the year 2019) specifies that almost all of the heterologous cycles was carried out with gametes acquired abroad (specifically, 97.8% of egg donation cycles and 90.3% of in vitro fertilization cycles with donated spermatozoa) – explains Allegra – It is also right to specify that the rates of Sub Area Pma are tariffs drawn up exclusively on costs, and therefore at the breakeven point, without any profit for public and private companies. they must also have their own legitimate business profit “. “If we compare the valuation of the tariffs, for example of a standard homologous cycle, of the draft Dpcm in question (€ 1,290) with that of the sub Area PMA (€ 2318) it is easy to understand how the difference is abysmal”. “Then of the two, one – says Allegra – or the Sub Area Pma (as mentioned, made up of experts in the field who have worked in Pma for decades, obviously collaborated by their management consultants) has proposed a completely overestimated rate or the enhancement of the draft of the DPCM it is absurdly incongruous. ” “It is still fair to point out that the Sub Area drafted these valuations in 2017 and the tariffs, at best, will actually enter into force after 5 years from their drafting, with costs of consumables, energy and services that, in relation to five-year inflation and the increase attributable to the coronavirus pandemic effect, they will have risen by at least 10% on the value of 2017 “.” So, if the proposed tariffs come into force, what will actually happen is that neither Public companies or accredited private ones will be able to offer the service, thus de facto the inclusion of assisted procreation in the LEA will be nullified and couples wishing to have offspring will still be forced to turn to the Italian or international private market “, concludes Adolfo Allegra.