title: HP-HMG versus rFSH in treatments combining fresh and frozen IVF cycles: success rates and economic evaluation.
abstract: The economic implications of the choice of gonadotrophin influence decision making but their cost-effectiveness in frozen-embryo transfer cycles has not been adequately studied. An economic evaluation was performed comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) using individual patient data (n=986) from two large randomized controlled trials using a long agonist IVF protocol. The simulation model incorporated live birth data and published UK costs of IVF-related medical resources. After treatment for up-to-three cycles (one fresh and up to two subsequent fresh or frozen cycles conditional on availability of cryopreserved embryos), the cumulative live birth rate was 53.7% (95% CI 49.3-58.1%) for HP-HMG and 44.6% (40.2-49.0%) for rFSH (OR 1.44, 95% CI 1.12-1.85; P<0.005). The mean costs per IVF treatment for HP-HMG and rFSH were pound5393 ( pound5341-5449) and pound6269 ( pound6210-6324), respectively (number needed to treat to fund one additional treatment was seven; P<0.001). With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound11,157 ( pound11,089-11,129) and pound14,227 ( pound14,183-14,222) with rFSH (P<0.001). The cost saving using HP-HMG remained after varying model parameters in a probabilistic sensitivity analysis.
authors.affiliation: PharmArchitecture, Quatro House, Lyon Way, Camberley, Surrey GU167ER, UK. jaro.wex@pharmarchitecture.com
authors.forename: Jaro
authors.initials: J
authors.lastname: Wex-Wechowski
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Setta
authors.forename: Sandy
authors.initials: S
authors.lastname: Kildegaard Nielsen
authors.forename: Richard
authors.initials: R
authors.lastname: Kennedy
mesh_terms: D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage*; D008962:Models, Theoretical; D011247:Pregnancy; D011256:Pregnancy Outcome; D011994:Recombinant Proteins / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D008596:Menotropins; D005640:Follicle Stimulating Hormone