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

Wechowski, Jaroslaw; Connolly, Mark P.; Schneider, D.; McEwan, P.; Kennedy, Rebekah

doi:10.1016/j.fertnstert.2008.01.034

Cited by 21 publications

(14 citation statements)

References 42 publications

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“…Because of this limited time period, reproductive specialists tend to use higher starting dose of gonadotropins to maximize the likelihood for future pregnancies. However, one should also consider the cost of gonadotropins, which represents a significant proportion, up to 30%, of the total expenditure for an IVF treatment cycle (15). FP procedures are generally excluded under infertility coverage, because the patients do not meet the classic definition of infertility.…”

Section: Discussionmentioning

confidence: 99%

Does higher starting dose of FSH stimulation with letrozole improve fertility preservation outcomes in women with breast cancer?

Lee

Oktay

2012

Fertility and Sterility

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Objective To evaluate the efficacy of ovarian stimulation with higher doses of gonadotropins in fertility preservation (FP) cycles with the intention to maximize the likelihood of future pregnancies. Design Retrospective (secondary analysis). Setting Academic medical centers. Patient(s) Low-dose (LD, 150 IU; n = 34) versus high-dose (HD, >150 IU; n = 117) FSH start in 151 patients with breast cancer (BCa) undergoing ovarian stimulation for embryo cryopreservation with letrozole (LE) before cancer treatment. Intervention(s) None. Main Outcome Measure(s) FP cycle outcomes. Result(s) Mean total FSH dose (2,037 ± 679 IU vs. 1,128 ± 381 IU) and FSH level on trigger day (21.1 ± 8.9 vs. 10.6 ± 4.5 mIU/mL) were higher in the HD group, confirming the receipt of higher-dose FSH. There was no difference in other patient characteristics. Despite the larger number of follicles >17 mm in diameter in the HD group (5.0 ± 2.0 vs. 3.4 ± 1.4), neither peak E2 (498.0 ± 377.5 vs. 397.9 ± 320.3), number of oocytes (13.3 ± 8.7 vs. 12.3 ± 8.0), nor number of embryos (6.3 ± 4.7 vs. 5.4 ± 3.8) were significantly different from the LD group. Of those undergoing frozen embryo transfer (ET), live birth rate (LBR)/ET trended higher in the LD (9/15) compared with HD (2/11) group, with 2.1 ± 0.8 vs. 1.9 ± 0.3 embryos transferred, respectively. Conclusion(s) Higher-dose FSH stimulation in LE cycles does not improve outcomes and may be associated with lower LBR. Our findings may support minimal stimulation in young noninfertile women with BCa.

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Section: Discussionmentioning

confidence: 99%

Does higher starting dose of FSH stimulation with letrozole improve fertility preservation outcomes in women with breast cancer?

Lee

Oktay

2012

Fertility and Sterility

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“…[8,9]. Other cost-effectiveness analyses have found that the cost of COH and IVF outcomes also depend on the clinical choice of medicines and GnRHagonist/GnRH-antagonist for ovarian stimulation and the duration of stimulation [10][11][12][13][14][15][16][17]. For evaluation of the protocols in many of these studies, the clinical end-point of interest is the number of live-born children.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level

Benbassat

Mitov

Savova

et al. 2016

Biotechnology & Biotechnological Equipment

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The aim of this study was to retrospectively analyse the cost-effectiveness of different types of controlled ovarian hyperstimulation (COH) protocols and regimes used in in vitro fertilization procedures at a national level. Information was gathered from the National Centre for Assisted Reproduction (Bulgaria). Out of 2849 patients, 2757 were included in the study. The patients were treated with three main protocols: gonadotrophin-releasing hormone (GnRH)-antagonist protocol, GnRH-agonist protocol and COH protocols without GnRH-analogues. In all main COH protocols, different types of gonadotrophins were combined in seven therapeutic schemes. A decision tree model was built for the cost-effectiveness analysis. Each decision node representing the three main COH protocols included seven possible chance nodes representing the COH therapeutic regimens. The results were evaluated based on the number of live-born children. The mean cost differed statistically significant between the three main types of protocols (p D 0.0001) and between all seven COH regimens. In terms of live birth, the GnRH agonist protocols were more effective, followed by GnRH-antagonist protocols and those without GnRH-analogues. The decision tree model confirmed that considering the probability of the therapeutic regimens being prescribed, the GnRH-agonist protocol is the cost-effective one with the smallest cost per live-born child (5033, 51 BGN). The other two protocols could also be considered cost-effective because the incremental cost effectiveness ratio is very low and is below the gross domestic product per capita for 2015. The Governmental Authorities, considering also the cost-effectiveness criteria, should carefully revise the trend towards a wider use of GnRH-antagonist protocols.

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“…Regarding the characteristics and response to stimulation of pregnant patients, there were no significant difference between the two groups regarding: infertility causes (unexplained infertility 92.3% in HP-hMG and 84.6% in rFSH; male factor 7.7% in HP-hMG and 15 …”

Section: Resultsmentioning

confidence: 82%

“…A noninferiority trial is appropriate when a new intervention has fewer adverse effects and/or lower costs, and one might accept a little less benefit that with the standard intervention (rFSH in this case) to gain the advantage in adverse effects or costs. It is well established that the overall costs of stimulated cycles are reduced using HP-hMG compared with rFSH in ICSI or IVF cycles (15).…”

mentioning

confidence: 99%

A prospective randomized noninferiority study comparing recombinant FSH and highly purified menotropin in intrauterine insemination cycles in couples with unexplained infertility and/or mild-moderate male factor

Sagnella¹,

Moro²,

Lanzone³

et al. 2011

Fertility and Sterility

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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

Cited by 21 publications

References 42 publications

Does higher starting dose of FSH stimulation with letrozole improve fertility preservation outcomes in women with breast cancer?

Does higher starting dose of FSH stimulation with letrozole improve fertility preservation outcomes in women with breast cancer?

Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level

A prospective randomized noninferiority study comparing recombinant FSH and highly purified menotropin in intrauterine insemination cycles in couples with unexplained infertility and/or mild-moderate male factor

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