University Hospital of Nantes, 38 Boulevard Jean Monnet, 44093, Nantes Cedex, France.
Reproductive Medicine Institute (IMR), 345, Avenue du Prado, 13008, Marseille, France.
Appl Health Econ Health Policy. 2018 Feb;16(1):65-77. doi: 10.1007/s40258-017-0361-7.
The objectives of this study were to assess (1) the expected cost of a live birth (LB) after in vitro fertilization with two different gonadotropin treatments [high purified human menopausal gonadotropin (HP-hMG) and recombinant follicle-stimulating hormone (rFSH)] as the single cost variable, and (2) the cost effectiveness of HP-hMG relative to rFSH in the context of the routine practice of assisted reproductive technology (ART) in France.
A Markov model was developed to simulate the therapeutic management, the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) courses, and the effects of complications in hypothetical cohorts of 30,000 patients undergoing IVF/ICSI with fresh embryo transfer (up to four attempts) using data from the MERIT and MEGASET clinical trials or from French routine ART practice.
The cost per LB was estimated at €12,145 and at €14,247 with HP-hMG and rFSH, respectively, using efficacy data from published clinical trials. The resulting incremental cost-effectiveness ratio (ICER) was - €11,616 per LB. HP-hMG was less expensive by around €15.0 million and more effective by 1289 additional LBs. Using French clinical data, the cost per LB was €16,415 and €18,7531 with HP-hMG and rFSH, respectively. The ICER for HP-hMG versus rFSH was estimated at - €7,719 per LB with a saving of about €8.54 million and 1097 additional LBs. Deterministic sensitivity analyses showed that the main ICER drivers were the LB rate, followed by the total gonadotropin doses. The probabilistic sensitivity analysis indicated that HP-hMG was the dominant strategy in 71.2% of cases using the clinical trial data and in 50.2% of cases using the French data.
This analysis indicates that compared with rFSH, HP-hMG is less costly for IVF/ICSI management from the French healthcare payer's viewpoint. The results of the present Markov model analysis are consistent with previous findings in other European countries.
本研究旨在评估（1）两种不同促性腺激素治疗方案（高纯度人绝经促性腺激素[HP-hMG]和重组卵泡刺激素[rFSH]）单次成本变量下体外受精（IVF）后的活产（LB）预期成本，以及（2）在法国常规辅助生殖技术（ART）实践背景下，HP-hMG 相对于 rFSH 的成本效益。
我们开发了一个马尔可夫模型，以模拟治疗管理、IVF/ICSI 疗程以及并发症的影响，该模型基于 MERIT 和 MEGASET 临床试验的数据或法国常规 ART 实践的数据，对 30000 名接受新鲜胚胎移植（最多 4 次尝试）的 IVF/ICSI 患者的假设队列进行了模拟。
使用已发表临床试验的疗效数据，我们估计使用 HP-hMG 和 rFSH 的 LB 单价分别为 12145 欧元和 14247 欧元。由此产生的增量成本效益比（ICER）为每 LB 节约 11616 欧元。HP-hMG 节省约 1500 万欧元，LB 增加 1289 个。使用法国临床数据，HP-hMG 和 rFSH 的 LB 单价分别为 16415 欧元和 18753 欧元。HP-hMG 与 rFSH 的 ICER 估计为每 LB 节约 7719 欧元，节省约 854 万欧元，LB 增加 1097 个。确定性敏感性分析表明，ICER 的主要驱动因素是 LB 率，其次是总促性腺激素剂量。概率敏感性分析表明，使用临床试验数据时，HP-hMG 是占优策略，占 71.2%；使用法国数据时，占 50.2%。
本分析表明，与 rFSH 相比，从法国医疗保健支付者的角度来看，HP-hMG 更能降低 IVF/ICSI 管理的成本。本马尔可夫模型分析的结果与其他欧洲国家的先前发现一致。
