Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Abstract

BackgroundDuring 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.MethodsData 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.ResultsCompleted 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.ConclusionsThis 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.

Mild Stimulation versus Conventional IVF: A Cost-Effectiveness Evaluation

“…This is likely due to the balance between the cost difference in total FSH dose per protocol and the price difference between GnRH agonist and antagonist treatment. Although the total length of stimulation and total FSH dose is less in mild-IVF, GnRH antagonist is more expensive than agonist treatment [5] [27] [28] [53]. It is important to note that our results apply to the mild-IVF protocol used in our model, which includes GnRH antagonist treatment and exogenous gonadotropins.…”

Low-cost in vitro fertilization: current insights

“…Thus, the price difference between these two protocols may not be large. A study in the United States indicated that on average, the cost of the GnRH agonist protocol is as much as USD $400 lower than that of the GnRH antagonist protocol 56. Thus, if the costs from this study can be applied universally, a GnRH agonist is generally the more cost-effective option in a limited resource setting.…”

Nimodipine, a calcium channel blocker, delays the spontaneous LH surge in women with regular menstrual cycles: a prospective pilot study

“…In current practice the LH surge is inhibited by GnRH agonists or antagonists, both of which ultimately suppress pituitary gonadotropin secretion [4]. Both these treatment options increase the need for multiple injections resulting in increased patient discomfort, inconvenience and overall costs [5]. Hence, an inexpensive oral medication, such as nimodipine, would be welcomed as a more convenient and cost effective approach if shown to be efficacious in preventing premature LH surges in ART protocols.…”

“…Current practice utilizes gonadotropin-releasing hormone (GnRH) agonists or antagonists that act centrally on the anterior pituitary gland to inhibit the release of LH and FSH, thus preventing spontaneous ovulation [4]. These medications are administered subcutaneously on a daily basis and are associated with prolonged treatment protocols, increased doses of gonadotropins for stimulation and added costs [5]. …”