Silverberg K, Schertz J, Falk B, Beresniak A
Texas Fertility Centre, Austin, TX, USA.
Reprod Biomed Online. 2002 Nov-Dec;5(3):265-9. doi: 10.1016/s1472-6483(10)61830-5.
This study compares the cost-effectiveness of recombinant human FSH (r(h)FSH, Gonal-F) and urinary FSH (uFSH) in assisted reproduction techniques in the USA, using several hypothetical prices for uFSH. A specifically designed Markov model and Monte-Carlo simulation techniques were used to model the possible outcomes during three treatment cycles. Data included in the model were derived from randomized clinical trials and databases. An expert panel determined probability distributions for each decision point throughout each virtual treatment cycle. The assumed unit cost of r(h)FSH was $58.52 (based on the average retail cost) and three unit prices ($49, $45, $40) were used for uFSH. A total of 5000 simulations was performed on a virtual cohort of 100,000 patients. The mean number of assisted reproduction treatment cycles/success (ongoing pregnancy at 12 weeks) was 4.34 with r(h)FSH and 4.75 with uFSH. The total number of pregnancies achieved was 40,665 and 37,890, respectively. The mean cost per successful pregnancy with r(h)FSH was $40 688. For uFSH at unit costs of $40, $45 and $49, the mean costs per successful pregnancy were $43,500, $44,400 and $45,000, respectively (each P < 0.0001 versus r(h)FSH). Thus, despite its greater cost per unit dose, r(h)FSH is more cost-effective than uFSH over a wide range of uFSH prices, reflecting the greater clinical efficacy of r(h)FSH.
本研究在美国辅助生殖技术中，使用尿促卵泡素（uFSH）的几种假设价格，比较重组人促卵泡素（r(h)FSH，果纳芬）和尿促卵泡素（uFSH）的成本效益。采用专门设计的马尔可夫模型和蒙特卡罗模拟技术，对三个治疗周期内的可能结果进行建模。模型中纳入的数据来自随机临床试验和数据库。一个专家小组确定了每个虚拟治疗周期中每个决策点的概率分布。假设的r(h)FSH单位成本为58.52美元（基于平均零售成本），uFSH使用了三个单位价格（49美元、45美元、40美元）。对100,000名患者的虚拟队列进行了总共5000次模拟。r(h)FSH辅助生殖治疗周期/成功（12周时持续妊娠）的平均次数为4.34次，uFSH为4.75次。实现的妊娠总数分别为40,665例和37,890例。r(h)FSH每例成功妊娠的平均成本为40,688美元。对于单位成本为40美元、45美元和49美元的uFSH，每例成功妊娠的平均成本分别为43,500美元、44,400美元和45,000美元（与r(h)FSH相比，各P<0.0001）。因此，尽管r(h)FSH每单位剂量成本更高，但在uFSH的广泛价格范围内，r(h)FSH比uFSH更具成本效益，这反映了r(h)FSH更高的临床疗效。
