title: Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients.
abstract: BACKGROUND
  During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF.
  
  
  METHODS
  Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied.
  
  
  RESULTS
  Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased.
  
  
  CONCLUSIONS
  This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.
authors.affiliation: Reproductive Research Division, Pacific Reproductive Center, PRC-Orange County, 10 Post, Irvine, CA 92618, USA. dr.sills@prc-ivf.com
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.forename: Gary S
authors.initials: GS
authors.lastname: Collins
authors.forename: Shala A
authors.initials: SA
authors.lastname: Salem
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jones
authors.forename: Alison C
authors.initials: AC
authors.lastname: Peck
authors.forename: Rifaat D
authors.initials: RD
authors.lastname: Salem
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002140:California; D017046:Cost Savings; D017281:Cost of Illness; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics* / Q000494:pharmacology; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000191:economics; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology; D006801:Humans; D007247:Infertility, Female / Q000191:economics / Q000628:therapy*; D007279:Injections, Subcutaneous; D057240:Patient Preference; D010594:Pharmacies / Q000191:economics; D012646:Self Administration / Q000009:adverse effects / Q000191:economics; D013315:Stress, Psychological / Q000209:etiology; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone