title: Analysis of the cost effectiveness of recombinant versus urinary follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection programs in the United States.
abstract: OBJECTIVE
  To compare the cost effectiveness of recombinant human FSH (Gonal-F; Serono, Inc., Randolph, MA) and urinary FSH (Fertinex; Serono, Inc.) for ovarian stimulation during IVF with or without intracytoplasmic sperm injection for the treatment of infertility.
  
  
  METHODS
  Clinical decision analysis techniques (the Markov model) were used to model the direct medical costs per patient during assisted reproductive technology.
  
  
  METHODS
  Clinical and economic outcomes of two different ovarian stimulation protocols (recombinant human FSH or urinary FSH) during three treatment cycles were considered.
  
  
  RESULTS
  More ongoing pregnancies were achieved, with fewer stimulation cycles, after recombinant human FSH (Gonal-F) than after urinary FSH (Fertinex) (40,665 versus 37,890). In addition, recombinant human FSH was also found to be more cost effective per ongoing pregnancy. From a societal perspective, the mean cost per pregnancy was $40,688 for recombinant human FSH versus $47,096 for urinary FSH. From the insurers' perspective, the mean cost/pregnancy for recombinant human FSH was $28,481 versus $32,967 for urinary FSH.
  
  
  CONCLUSIONS
  Recombinant human FSH (Gonal-F) is not only more efficient clinically than urinary FSH (Fertinex), but also more cost effective. This analysis illustrates the point that the economic effectiveness of a drug depends less on its acquisition costs and rather more on the clinical outcomes associated with its use.
authors.affiliation: Texas Fertility Center, Austin, Texas 78705, USA. kaylen@txfertility.com
authors.forename: Kaylen
authors.initials: K
authors.lastname: Silverberg
authors.forename: Salim
authors.initials: S
authors.lastname: Daya
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Auray
authors.forename: Gerald
authors.initials: G
authors.lastname: Duru
authors.forename: William
authors.initials: W
authors.lastname: Ledger
authors.forename: Matts
authors.initials: M
authors.lastname: Wikland
authors.forename: Renda
authors.initials: R
authors.lastname: Bouzayen
authors.forename: Mark
authors.initials: M
authors.lastname: O'Brien
authors.forename: Barri
authors.initials: B
authors.lastname: Falk
authors.forename: Ariel
authors.initials: A
authors.lastname: Beresniak
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use* / Q000652:urine; D006801:Humans; D007248:Infertility, Male / Q000628:therapy; D008297:Male; D008390:Markov Chains; D011247:Pregnancy / Q000706:statistics & numerical data*; D011994:Recombinant Proteins / Q000627:therapeutic use; D020554:Sperm Injections, Intracytoplasmic / Q000191:economics*; D014481:United States
chemical_list: D011994:Recombinant Proteins; D005640:Follicle Stimulating Hormone