Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level

Abstract

The aim of this study was to retrospectively analyse the cost-effectiveness of different types of controlled ovarian hyperstimulation (COH) protocols and regimes used in in vitro fertilization procedures at a national level. Information was gathered from the National Centre for Assisted Reproduction (Bulgaria). Out of 2849 patients, 2757 were included in the study. The patients were treated with three main protocols: gonadotrophin-releasing hormone (GnRH)-antagonist protocol, GnRH-agonist protocol and COH protocols without GnRH-analogues. In all main COH protocols, different types of gonadotrophins were combined in seven therapeutic schemes. A decision tree model was built for the cost-effectiveness analysis. Each decision node representing the three main COH protocols included seven possible chance nodes representing the COH therapeutic regimens. The results were evaluated based on the number of live-born children. The mean cost differed statistically significant between the three main types of protocols (p D 0.0001) and between all seven COH regimens. In terms of live birth, the GnRH agonist protocols were more effective, followed by GnRH-antagonist protocols and those without GnRH-analogues. The decision tree model confirmed that considering the probability of the therapeutic regimens being prescribed, the GnRH-agonist protocol is the cost-effective one with the smallest cost per live-born child (5033, 51 BGN). The other two protocols could also be considered cost-effective because the incremental cost effectiveness ratio is very low and is below the gross domestic product per capita for 2015. The Governmental Authorities, considering also the cost-effectiveness criteria, should carefully revise the trend towards a wider use of GnRH-antagonist protocols.

Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

“…Comparing our results with those of the previous studies is limited, because the latter had less strict inclusion criteria (e.g., including not only poor responders), a different design (e.g., trial-based and model based economic evaluations), different perspectives (e.g., costs related to sick leave, obstetric and post-natal costs of live births), and different outcomes (e.g., pregnancy within 1 year leading to term live birth). However, one study found no difference in pregnancy rate between the two treatment protocols (Polinder et al, 2008), while the other two studies showed that the MS-IVF was more effective than C-IVF (Crawford et al, 2016;Benbassat et al, 2017). Overall, our findings are in line with their conclusions, namely that MS-IVF is more likely to be cost-effective than C-IVF.…”

“…However, one study found no difference in pregnancy rate between the two treatment protocols ( Polinder et al. , 2008 ), while the other two studies showed that the MS-IVF was more effective than C-IVF ( Crawford et al , 2016 ; Benbassat et al , 2017 ). Overall, our findings are in line with their conclusions, namely that MS-IVF is more likely to be cost-effective than C-IVF.…”

“…In addition, research has shown that assisted reproduction treatments are more costly for women aged 40 or over compared with younger women because success rates are lower ( Chambers et al , 2006 ). This has led to a debate about the viability of using private and public funds for treating women with low chances of pregnancy success worldwide ( Griffiths et al , 2010 ; Dyer et al , 2013 ; Stephen et al , 2016 ; Benbassat et al , 2017 ) and in Brazil in particular ( Souza, 2014 ; Corrêa & Loyola, 2015 ). Our finding that MS-IVF is likely to be cost-saving compared to C-IVF in poor responders may add to this debate.…”

“…Comparison with other cost-effectiveness studies Until now, relatively few studies assessed the cost-effectiveness of MS-IVF compared to C-IVF. We only found three of such studies, including two in a European population (i.e., Dutch and Bulgarian) and one in a US population (Polinder et al, 2008;Crawford et al, 2016;Benbassat et al, 2017). Comparing our results with those of the previous studies is limited, because the latter had less strict inclusion criteria (e.g., including not only poor responders), a different design (e.g., trial-based and model based economic evaluations), different perspectives (e.g., costs related to sick leave, obstetric and post-natal costs of live births), and different outcomes (e.g., pregnancy within 1 year leading to term live birth).…”