title: A cost-effectiveness evaluation comparing originator follitropin alfa to the biosimilar for the treatment of infertility.
abstract: OBJECTIVE
  To perform a cost-effectiveness evaluation comparing the originator follitropin alfa (Gonal-f®) to the biosimilar (Bemfola®) in the Italian and Spanish contexts, with an assessment of the German and UK backgrounds.
  
  
  METHODS
  Starting from the study by Rettenbacher et al, a cost-effectiveness model was developed in the Italian and Spanish contexts. Clinical data on subjects, doses of gonadotropin, pregnancies, live-born children, and ovarian hyperstimulation syndrome were used to feed the model. Costs related to drugs, hospitalizations, specialist visits, and examinations were retrieved from Italian and Spanish tariffs. Gonadotropin acquisition costs for Germany and the UK were also taken into account to expand the economical assessment to the other countries. The evaluation was done based on the National Health Service perspective. Sensitivity analyses, both univariate and probabilistic, as long as scenario analyses, tested the robustness of the model.
  
  
  RESULTS
  Originator follicle-stimulating hormone (FSH) costs were €3,663 and €6,387 in Italy and Spain, respectively, whereas biosimilar FSH costs were €3,483 and €6,342. The efficacy was found to be 0.52 for the originator and 0.47 for the biosimilar. The average cost per live birth was estimated to be €7,044 and €12,283 for the originator FSH and €7,411 and €13,494 for the biosimilar for Italy and Spain, respectively. Furthermore, the originator FSH generated an incremental cost-effectiveness ratio of €3,600 for Italy and €900 for Spain compared to the biosimilar. Sensitivity analyses confirmed the results of the base case model.
  
  
  CONCLUSIONS
  This analysis indicated that the originator FSH is a cost-efficient treatment strategy for Italian and Spanish health services compared to the biosimilar and it would be worthwhile extending this evaluation to other countries.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Department of Obstetrics and Gynecology, Rey Juan Carlos University Madrid, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Garcia-Velasco
authors.affiliation: IMS Health Information Solutions Italy Srl, Milan, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Heiman
authors.affiliation: IMS Health Information Solutions Italy Srl, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ripellino
authors.affiliation: Centre for Gynaecology, Endocrinology, and Reproductive Medicine, Ulm and Stuttgart, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bühler
keywords: FSH; biosimilar; follitropin alfa; infertility