title: Cost-effectiveness modelling of recombinant FSH versus urinary FSH in assisted reproduction techniques in the UK.
abstract: BACKGROUND
  The purpose of this study was to undertake an economic evaluation to compare the cost-effectiveness of recombinant (r)FSH with urinary (u)FSH for attaining clinical pregnancy with assisted reproduction.
  
  
  METHODS
  Mathematical modelling was utilized incorporating a Markovian decision framework and a Monte Carlo simulation. Statistical representations of recurrent events over time were incorporated into a decision analysis involving fresh and frozen cycles in any sequence (after the first fresh embryo transfer cycle) over three successive assisted reproduction attempts. The mean values of transition probabilities were derived from randomized controlled clinical trials and published reports. The distributions of these transition probabilities were agreed upon by a panel of experts. Cost data for procedures and drugs were derived and validated according to the perspectives of the National Health Service and private clinics in the UK.
  
  
  RESULTS
  The study involved 5000 Monte-Carlo simulations of treatment on a Markov cohort of 100 000 patients. The total number of pregnancies attained was significantly higher in the rFSH (40 575) compared with the uFSH (37 358) group. The cost per successful pregnancy was significantly lower for rFSH (5906 pounds sterling) compared with uFSH (6060 pounds sterling) and overall, fewer cycles of treatment were required with rFSH to achieve an ongoing pregnancy. The incremental cost-effectiveness ratio is 4148 pounds sterling for each additional clinical pregnancy with rFSH.
  
  
  CONCLUSIONS
  In addition to the increased effectiveness of rFSH in ART, this study demonstrated that it is more cost-effective and more efficient than uFSH in attaining an ongoing pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton Ontario, Canada. dayas@mcmaster.ca
authors.forename: S
authors.initials: S
authors.lastname: Daya
authors.forename: W
authors.initials: W
authors.lastname: Ledger
authors.forename: J P
authors.initials: JP
authors.lastname: Auray
authors.forename: G
authors.initials: G
authors.lastname: Duru
authors.forename: K
authors.initials: K
authors.lastname: Silverberg
authors.forename: M
authors.initials: M
authors.lastname: Wikland
authors.forename: R
authors.initials: R
authors.lastname: Bouzayen
authors.forename: C M
authors.initials: CM
authors.lastname: Howles
authors.forename: A
authors.initials: A
authors.lastname: Beresniak
mesh_terms: D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004624:Embryo Transfer; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use* / Q000652:urine*; D005865:Gestational Age; D006801:Humans; D008390:Markov Chains; D008433:Mathematics; D018803:Models, Economic; D009010:Monte Carlo Method; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use; D012099:Reproductive Techniques; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D011994:Recombinant Proteins; D005640:Follicle Stimulating Hormone