title: Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women.
abstract: BACKGROUND
  Hypogonadotropic hypogonadal women are characterized by ovarian functionality deficiency, caused by low concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). To recover reproduction functionality, recommended therapies for ovarian induction involve injections of FSH and LH medications.
  
  
  OBJECTIVE
  Since important differences exist between recombinant and urinary gonadotropin therapies in terms of efficacy and cost, the objective of this study was to develop a cost-effectiveness model to compare recombinant FSH (rFSH) + recombinant LH (rLH) and highly purified human menopausal gonadotropin (HP-HMG).
  
  
  METHODS
  A Markov model was developed, considering three cycles of therapy; probability of pregnancy and miscarriage were considered, and the efficacy was evaluated in terms of pregnancy occurrence. The perspective of the model was that of the Italian Health Service, so only direct cost (drugs, specialist visits, patient examinations, and hospitalizations) were included.
  
  
  RESULTS
  rFSH + rLH is associated with a higher total cost (€3,453.50) and higher efficacy (0.87) compared with HP-HMG (€2,719.70 and 0.50). rFSH + rLH generated an incremental cost effectiveness ratio equal to €2,007.30 compared to HP-HMG; the average cost per pregnancy is estimated to be €3,990.00 for recombinant strategy and €5,439.80 for urinary strategy. Results of probabilistic sensitivity analysis were consistent with the abovementioned findings.
  
  
  CONCLUSIONS
  Despite the higher acquisition cost in comparison to HP-HMG, rFSH + rLH resulted in a higher pregnancy rate, which makes it the recommended choice when considering cost-effectiveness of LH in supporting FSH-induced follicular gonadotropins in hypogonadotropic hypogonadal women.
authors.affiliation: Centro Scienze della Natalità, Gynecological-Obstetrics Department, San Raffaele Hospital, Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Papaleo
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Alviggi
authors.affiliation: Department of Drug Sciences, University of Pavia, Pavia, Italy ; SAVE Studi Analisi Valutazioni Economiche, Milan, Italy.
authors.forename: Giorgio Lorenzo
authors.initials: GL
authors.lastname: Colombo
authors.affiliation: ACO San Filippo Neri, Rome, Italy ; Società Italiana Di Farmacia Ospedaliera, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pisanelli
authors.affiliation: CSD Medical Research Srl, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ripellino
authors.affiliation: Medical Department, Merck Serono SpA, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Longobardi
authors.affiliation: Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Canonico
keywords: HP-HMG; gonadotropin; hypogonadotropic hypogonadism