Cost-saving treatment strategies in in vitro fertilization: a combined economic evaluation of two large randomized clinical trials comparing highly purified human menopausal gonadotropin and recombinant follicle-stimulating hormone alpha
Received 8 October 2007; received in revised form 8 January 2008; accepted 8 January 2008. published online 12 March 2008.
Objective
To assess the cost-effectiveness of two gonadotropin treatments that are available in the United Kingdom in light of limited public funding and the fundamental role of costs in IVF treatment decisions.
Design
An economic evaluation based on two large randomized clinical trials in IVF patients using a simulation model.
Setting
Fifty-three fertility clinics in 13 European countries and Israel.
Patient(s)
Women indicated for treatment with IVF (N = 986), aged 18–38, participating in double-blind, randomized controlled trials.
Cost per IVF cycle and cost per live birth for HP-hMG and rFSH alpha.
Result(s)
HP-hMG was more effective and less costly versus rFSH for both IVF cost per live birth and for IVF cost per baby (incremental cost-effectiveness ratio was negative). The mean costs per IVF treatment for HP-hMG and rFSH were £2408 (95% confidence interval [CI], £2392, £2421) and £2660 (95% CI £2644, £2678), respectively. The mean cost saving of £253 per cycle using HP-hMG allows one additional cycle to be delivered for every 9.5 cycles.
Conclusion(s)
Treatment with HP-hMG was dominant compared with rFSH in the United Kingdom. Gonadotropin costs should be considered alongside live-birth rates to optimize outcomes using scarce health-care resources.
aHealth Economics, Cardiff Research Consortium, Cardiff, United Kingdom
bHealth Economics, Ferring International Center, St. Prex, Switzerland
cSchool of Mathematics, Cardiff University, Cardiff, United Kingdom
dCentre for Reproductive Medicine, University Hospital, Coventry, United Kingdom
Reprint requests: Mark Connolly, Director Market Access, Ferring International Center SA, Chemin de Vergognausaz 50, CH-1162, St. Prex, Switzerland (FAX: 41-0-58-301-0371).
This study was funded by Ferring Pharmaceuticals, St. Prex, Switzerland.
Dr. Jaroslaw Wechowski and Dr. Philip McEwan are academic consultants who provide health-consulting services to pharmaceutical and medical device companies and governments. Dr. Jaroslaw Wechowski is the owner of Pharmarchitecture Limited, a consultancy for pharmaceutical companies not involved in the current study. Dr. Richard Kennedy is clinical director of the University Hospital Centre for Reproductive Medicine in Coventry and has worked as a nonremunerated advisor to this project. Mark Connolly and Dirk Schneider are employees of Ferring Pharmaceuticals.
The results of this study were presented in an abbreviated format at the European Society for Human Reproduction and Embryology meeting, which was held in Lyon, France, in July 2007.
ABSTRACT