An economic evaluation of highly purified HMG and recombinant FSH based on a large randomized trial

Abstract

Public funding for IVF is increasingly being challenged by health authorities in an attempt to minimize health service costs. In light of treatment rationing, the need to consider costs in relation to outcomes is paramount. To assess the cost implications of gonadotrophin treatment options, an economic evaluation comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) has been conducted. The analysis is based on individual patient data from a large randomized controlled trial (n = 731) in a long agonist IVF protocol. The economic evaluation uses a discrete event simulation model to assess treatment costs in relation to live births for both treatments based on published UK costs. After one cycle the mean costs per IVF treatment for HP-HMG and rFSH were pound2396 (95% CI pound2383-2414) and pound2633 ( pound2615-2652), respectively. The average cost-saving of pound237 per IVF cycle using HP-HMG allows one additional cycle to be delivered for every 10 cycles. With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound8893 compared with pound11,741 for rFSH (P < 0.001). The cost-saving potential of HP-HMG in IVF was still apparent after varying critical cost parameters in the probabilistic sensitivity analysis.

Cost-saving treatment strategies in in vitro fertilization: a combined economic evaluation of two large randomized clinical trials comparing highly purified human menopausal gonadotropin and recombinant follicle-stimulating hormone alpha

“…For example, NICE guidelines published in 2004 suggest an average IVF cost per cycle of £2771 (6). A recently published assessment of costs based on the MERiT clinical data alone suggested that the costs of HP-hMG and rFSH treatment were £2396 and £2633, respectively (27). In addition, Lloyd et al established that the cost for one IVF cycle was £2423 with HP-hMG and £2745 with rFSH; however, these estimates are based on a combined IVF and ICSI population (26).…”

“…HP-hMG alone was compared with rFSH, but the analysis combined IVF and intracytoplasmic sperm injection (ICSI) patients (26). Of all identified economic studies involving HP-hMG, only one was based on patient-level data from a randomized trial (27), and in one, efficacy data were extracted from a meta-analysis (24). While many studies reported cost per clinical or ongoing pregnancy (18,19,(22)(23)(24)(25)(26)28), cost per live birth or per baby was addressed less frequently (29) and mainly in studies not involving comparison of gonadotropins (27).…”

“…Only one study involving HP-hMG and rFSH was conducted in the UK setting, although it was not specific to IVF patients (26). Our previous study comparing HP-hMG and rFSH in IVF patients in the UK setting was a cost-minimization analysis (27) based on one clinical trial only (30). Pooling of two large randomized controlled trials (RCTs) allowed us to conduct the first analysis of live-birth rates after stimulation with the two gonadotropins and of the related costs in IVF patients in the UK.…”

“…Based on a randomized clinical trial, menotropin was found to be less expensive per cycle in the UK when compared with rFSH, allowing 13% more cycles to be offered (13,26). A recent study based on a simulation model using outcomes from an RCT demonstrated cost-savings resulting from using HP-hMG instead of rFSH (27,30). Menotropin was also found to be cost saving compared with rFSH in a model based on a meta-analysis of clinical trials (25).…”

Clinical Efficacy of Highly Purified hMG versus Recombinant FSH in IVF/ICSI Cycles: A Meta-Analysis

“…An economic analysis is therefore also considered to guide both couples and infertility practitioners. Three articles compared the cost-effectiveness of rFSH versus urinary gonadotropins: Menopur is consistently found to be less expensive than rFSH in terms of mean cost per treatment cycle and/or the cost per ongoing pregnancy [20][21][22] .…”