de Mouzon J, Allavena E, Schmitt C, Frappé M
Inserm U569, hôpital de Bicêtre, 78, avenue du Général-Leclerc, 94272 Le Kremlin-Bicêtre, France.
Gynecol Obstet Fertil. 2004 Jun;32(6):508-18. doi: 10.1016/j.gyobfe.2004.05.002.
The objective of the study was to make an economic evaluation of in vitro fertilization and to determine the impact of some factors on its cost, particularly the choice between recombinant follicle stimulating hormone (r-FSH) and urinary FSH (u-FSH) for ovarian stimulation.
Costs were calculated in a Public Health view, by studying two phases: the stimulation cycle (including down-regulation) and the pregnancy (including the neonatal period). The calculation has included the side effects and the frozen embryos transfers. Economic data came from various sources: the French nomenclature on medical treatments (NGAP), the French drugs dictionary (Vidal) and the French Information system medical plan (PMSI). FSH costs were computed according to the currently marketed products, i.e., Fostimon (Laboratoires Genévrier, Sophia-Antipolis, France) for urinary FSH, and Gonal-F (Laboratoires Serono, Boulogne-Billancourt, France) and Puregon (Laboratoires Organon, Puteaux, France) for recombinant FSH. Two different ways of efficacy between u-FSH and r-FSH were considered for the calculations, those reported in Daya's meta-analysis (3.7% in favour of r-FSH for the clinical pregnancy rate per initiated cycle) and in the only double-blind study (Frydman et al., no difference).
The annual cost of ART reaches approximately 130 million Euros in France, for the cycles only, and 170 million Euros when including the pregnancy costs. Urinary FSH is much cheaper than recombinant FSH. Whereas the number of administered FSH units was higher in u-FSH, this results in a mean lower cost of 500 Euros per cycle (2422 Euros for u-FSH and 2959 Euros for r-FSH). For one complete year, in France, the potential over cost of recombinant products reaches 24 million Euros when considering only the cycles (128.4 vs. 104.0 million Euros) and 24-31 million Euros when pregnancies and babies (neonatal period) are considered (171.4 vs 140.7 and 147.0 million Euros, respectively). The IVF per baby cost can be estimated at 16 463 Euros for r-FSH and at 14 116 Euros (in case of equivalence between the two drugs) to 15 805 Euros (in case of a difference of 3.7% pregnancy per oocyte recovery) for u-FSH.
This gives Public Health lighting to the choices in the matter of ovulation stimulation. It shows the economic impact of the choice in the FSH type.
本研究旨在对体外受精进行经济评估，并确定某些因素对其成本的影响，特别是在卵巢刺激中重组促卵泡激素（r-FSH）和尿促卵泡素（u-FSH）之间的选择。
从公共卫生角度计算成本，研究两个阶段：刺激周期（包括降调节）和妊娠（包括新生儿期）。计算包括副作用和冷冻胚胎移植。经济数据来自各种来源：法国医疗治疗术语表（NGAP）、法国药品词典（Vidal）和法国医疗计划信息系统（PMSI）。FSH成本根据目前市场上销售的产品计算，即尿促卵泡素使用Fostimon（法国索菲亚安提波利斯的Genévrier实验室），重组促卵泡素使用果纳芬（法国布洛涅-比扬古的雪兰诺实验室）和普利康（法国叙雷讷的欧加农实验室）。计算中考虑了u-FSH和r-FSH两种不同的疗效方式，即达亚荟萃分析中报告的（每个启动周期的临床妊娠率有利于r-FSH 3.7%）和唯一的双盲研究（弗里德曼等人，无差异）。
在法国，仅就周期而言，辅助生殖技术的年度成本约为1.3亿欧元，包括妊娠成本时为1.7亿欧元。尿促卵泡素比重组促卵泡素便宜得多。虽然u-FSH中使用的FSH单位数量较多，但这导致每个周期的平均成本降低500欧元（u-FSH为2422欧元，r-FSH为2959欧元）。在法国，仅考虑周期时，重组产品的潜在额外成本达到2400万欧元（1.284亿欧元对1.04亿欧元），考虑妊娠和婴儿（新生儿期）时为2400万至3100万欧元（分别为1.714亿欧元对1.407亿欧元和1.47亿欧元）。每个婴儿的体外受精成本估计r-FSH为16463欧元，u-FSH为14,116欧元（两种药物等效时）至15,805欧元（每个卵母细胞回收的妊娠差异为3.7%时）。
这为公共卫生在排卵刺激问题上的选择提供了启示。它显示了FSH类型选择的经济影响。
