Decision analysis about the cost-effectiveness of different in vitro fertilization-embryo transfer protocol under considering governments, hospitals, and patient

Abstract

Objective: The aim of this study was to explore the benefits of in vitro fertilization (IVF) for patients and hospitals under different protocols and if IVF treatment should be incorporated into health care. Perspective: The government should consider including IVF treatment in health insurance. Hospitals and patients could obtain the best benefit by following the hospital's recommended protocol. Setting: This retrospective study was conducted from January 2014 to August 2017 at an academic hospital. Methods: A total of 7440 patients used gonadotropin-releasing hormone agonists (GnRHa) protocol, 2619 patients used, gonadotropin-releasing hormone antagonists (GnRHant) protocol, and 1514 patients used GnRHa ultra-long protocol. Primary outcomes were live birth rate (LBR), cost-effectiveness, hospital revenue, and government investment. Results: The cycle times for the GnRHa protocol and the GnRHa ultra-long protocol were significantly higher than the GnRHant protocol. Patients who were ≤29 years chose the GnRHant protocol. The cost of a successful cycle was 67,579.39 ± 9,917.55 ¥ and LBR was 29.25%. Patients who were >30 years had the GnRHa protocol as the dominant strategy, as it was more effective at lower costs and higher LBR. When patients were >30 to ≤34 years, the cost of a successful cycle was 66,556.7 ± 8,448.08 ¥ and the LBR was 31.05%. When patients were >35 years, the cost of a successful cycle was 83,297.92 ± 10,918.05 ¥ and the LBR was 25.07%. The government reimbursement for a cycle ranged between 11,372.12 ± 2,147.71 ¥ and 12,753.67 ± 1,905.02 ¥. Conclusions: The government should consider including IVF treatment in health insurance. Hospitals recommend the GnRHant protocol for patients <29 years old and the GnRHa protocol for patients >30 years old, to obtain the best benefits. Patients could obtain the best benefit by using the protocol recommended by the hospital.

Controlled Ovarian Hyperstimulation Protocol in Infertile Patients During the COVID-19 Pandemic

“…Our study showed that one full-dose depot of long-acting GnRH-a per COH cycle would be more suitable and convenient for infertile couples than GnRH antagonist and short-acting GnRH-a injections during the COVID-19 pandemic because there are fewer possible incidences of potential exposure ( Ren et al, 2014 ; Li F. et al, 2020 ). Some studies previously observed that a pituitary downregulated full-dose may require a higher dose of gonadotropins for ovarian stimulation ( Pan et al, 2019 ; Xu et al, 2020 ); however, our study showed that the total dosage of Gns used in our study was not statistically different among the treatment groups, which means a full dose of gonadotropins or prolonged pituitary downregulation would not drastically increase the economic burden for Infertile couples.…”

Association Between Fresh Embryo Transfers and Frozen–Thawed Embryo Transfers Regarding Live Birth Rates Among Women Undergoing Long Gonadotropin-Releasing Hormone Antagonist Protocols

“…The findings of this study have several strengths. First, the cost of a successful cycle in the GnRH antagonist protocol is high, ranging from ¥6,757.39 to ¥153,327.20 ( Pan et al, 2019 ). Although the GnRH antagonist protocol is better than other protocols in terms of psychosocial and physical well-being during the first ART treatment ( Toftager et al, 2018 ), these data, considering the significant financial investment, may influence physician recommendation or patients’ decision-making regarding a COH protocol and a fresh embryo transfer vs. FET a priori for convenience.…”

Initial ovarian sensitivity index predicts embryo quality and pregnancy potential in the first days of controlled ovarian stimulation

“…This has an unfortunate consequence, given the fact that the main costs of an IVF cycle occur once the ova are collected. If the IVF cycle results in poor-quality ova, there is no possibility of stopping the procedure in time to restart the cycle to achieve a better stimulation [19]. Hassan et al described the follicular sensitivity index (FSI).…”