title: Economic evaluation of highly purified human menopausal gonadotropin versus recombinant human follicle-stimulating hormone in fresh and frozen in vitro fertilization/intracytoplasmic sperm-injection cycles in Sweden.
abstract: Gonadotropin-releasing hormone-analog type, fertilization method, and number of embryos available for cryopreservation should be incorporated into economic evaluations of highly purified human menopausal gonadotropin (HP-hMG) and recombinant human follicle-stimulating hormone (r-hFSH), as they may affect treatment costs. We searched for randomized trials and meta-analyses comparing HP-hMG and r-hFSH. Meta-analysis showed no significant difference in live births (odds ratio 0.82, 95% confidence interval [CI] 0.66-1.01), but a greater number of oocytes with r-hFSH (mean difference [MD] 1.96, 95% CI 1.02-2.90). Using a cost-minimization model for Sweden, accounting for embryo availability, survival following thawing, and patient dropout, we simulated patients individually for up to three cycles. R-hFSH was found to be cost-saving, at 2,767 kr (95% CI 1,580-4,057) per patient (€315 or $411); baseline savings were 6.43% of the total HP-hMG cost. In fresh cycles only, the savings for r-hFSH were 1,752 kr (95% CI 48-3,658) per patient (€200 or $260). In univariate sensitivity analyses, savings were obtained until the price of r-hFSH increased by 30% or the dosage of HP-hMG decreased by 38%-62% of baseline value. In probabilistic sensitivity analysis, r-hFSH was cost-saving in 100% of the simulated cohort per patient and in 85% per live birth; the respective percentages for fresh cycles only were 97.3% and 73.1%. In conclusion, a greater number of oocytes with r-hFSH allows for more frozen embryo transfers, thereby reducing overall treatment cost.
authors: PharmArchitecture, London, UK.
authors: Jaro
authors: J
authors: Wex
authors: Ahmed M
authors: AM
authors: Abou-Setta
keywords: cryopreservation; economic analysis; highly purified menopausal gonadotropin; in vitro fertilization; meta-analysis; recombinant human FSH
references: Med Arh. 2011;65(3):153-6
references: 21776876
references: N Engl J Med. 2009 Jan 15;360(3):236-43
references: 19144939
references: MMWR Surveill Summ. 2008 Jun 20;57(5):1-23
references: 18566567
references: Reprod Biomed Online. 2008 Nov;17(5):676-83
references: 18983752
references: Reprod Biomed Online. 2010 Aug;21(2):166-78
references: 20541471
references: Hum Reprod. 2008 Oct;23(10):2346-51
references: 18583332
references: Fertil Steril. 2010 Nov;94(6):2467-9
references: 20537626
references: Reprod Biol Endocrinol. 2010 Nov 08;8:137
references: 21059191
references: Hum Reprod. 2010 Aug;25(8):1851-62
references: 20570973
references: Lakartidningen. 2005 Nov 14-20;102(46):3444-7, 3449
references: 16335725
references: Fertil Steril. 2002 Sep;78(3):520-8
references: 12215327
references: Ann N Y Acad Sci. 2008 Apr;1127:49-58
references: 18443329
references: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD005354
references: 21328276
references: Hum Reprod. 2011 Mar;26(3):569-75
references: 21163856
references: Reprod Biomed Online. 2003 Oct;7(3):286-94
references: 14653884
references: Gynecol Endocrinol. 2012 Jul;28(7):540-4
references: 22390186
references: Reprod Biomed Online. 2010 Feb;20(2):209-22
references: 20113959
references: Hum Reprod. 2006 Jan;21(1):210-6
references: 16172148
references: Ir Med J. 2008 Jun;101(6):181-4
references: 18700513
references: Reprod Biol Endocrinol. 2010 Sep 16;8:112
references: 20846363
references: Hum Reprod. 2001 Dec;16(12):2563-9
references: 11726575
references: Reprod Biomed Online. 2010 Aug;21(2):151-8
references: 20570564
references: Obstet Gynecol. 2012 Jan;119(1):44-9
references: 22183210
references: Hum Reprod. 2003 Jun;18(6):1194-9
references: 12773445
references: Hum Reprod. 2013 May;28(5):1375-90
references: 23442757
references: Reprod Biomed Online. 2007 Apr;14(4):430-5
references: 17425822
references: Hum Reprod. 2007 Sep;22(9):2404-13
references: 17640944
references: Fertil Steril. 2008 Jun;89(6):1685-93
references: 17681325
references: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003414
references: 18254019
references: Hum Reprod. 1991 Feb;6(2):284-9
references: 1905316
references: Reprod Biomed Online. 2004 May;8(5):600-6
references: 15151731
references: Cochrane Database Syst Rev. 2012 Jul 11;(7):CD002118
references: 22786480
references: Hum Reprod. 2008 Feb;23(2):310-5
references: 18056719
references: N Engl J Med. 2009 Oct 29;361(18):1812-3
references: 19864685
references: Fertil Steril. 2011 Nov;96(5):1121-5.e1
references: 21890133
references: Hum Reprod. 2012 Mar;27(3):760-9
references: 22240210
references: Clinicoecon Outcomes Res. 2012;4:185-92
references: 22888264
references: Gynecol Obstet Invest. 2010;70(2):132-7
references: 20389096
references: Fertil Steril. 2013 May;99(6):1689-94
references: 23395364
references: Hum Reprod. 2003 Jun;18(6):1313-8
references: 12773465
references: Fertil Steril. 2009 May;91(5):1820-30
references: 18439596
references: Hum Reprod. 2008 Sep;23(9):2050-5
references: 18544578
references: Hum Reprod. 1998 Feb;13(2):403-8
references: 9557847
references: Fertil Steril. 2013 Jan;99(1):156-162
references: 23040524
references: Fertil Steril. 2010 Aug;94(3):958-64
references: 19931075
references: Hum Reprod. 2010 Apr;25(4):924-31
references: 20106837
references: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003416
references: 19370588
references: Reprod Biomed Online. 2012 Mar;24(3):261-71
references: 22285265
references: BMJ. 2010 Dec 21;341:c6945
references: 21177530
references: J Assist Reprod Genet. 2010 Jul;27(7):357-63
references: 20373015
references: Acta Obstet Gynecol Scand. 2010 Aug;89(8):1053-60
references: 20602599
references: Reprod Biomed Online. 2008 Jan;16(1):81-8
references: 18252052
references: Int J Technol Assess Health Care. 2008 Spring;24(2):133-9
references: 18400114
references: Hum Reprod. 1994 Jan;9(1):103-9
references: 8195330
references: Fertil Steril. 2004 May;81(5):1401-4
references: 15136112
references: Hum Reprod. 2012 Sep;27(9):2571-84
references: 22786779
references: Fertil Steril. 2012 Mar;97(3):561-71
references: 22244781
references: Hum Reprod. 2011 Jul;26(7):1768-74
references: 21558332
references: Reprod Biol Endocrinol. 2010 Mar 12;8:25
references: 20226040
references: Am J Perinatol. 2013 Apr;30(4):253-60
references: 22918680
references: Hum Reprod. 2011 May;26(5):964-6
references: 21372045
references: J Assist Reprod Genet. 1999 Sep;16(8):416-20
references: 10478320
references: Fertil Steril. 2000 Sep;74(3):495-7
references: 10973644
references: Gynecol Endocrinol. 2009 Jun;25(6):372-8
references: 19340668
references: Hum Reprod. 2006 Feb;21(2):518-23
references: 16239314
references: J Turk Ger Gynecol Assoc. 2011 Mar 01;12(1):15-20
references: 24591951
references: Hum Reprod Update. 2011 Jul-Aug;17(4):454-66
references: 21531751
references: Hum Reprod. 2006 Dec;21(12):3217-27
references: 16873892
references: J Clin Epidemiol. 2011 Jan;64(1):11-20
references: 20189767
references: Reprod Biomed Online. 2003 Nov;7(5):587-92
references: 14680555
references: J Clin Pharm Ther. 2008 Aug;33(4):401-7
references: 18613858