School of Medical Informatics, Chongqing Medical University, Chongqing, China.
School of Pharmacy, Chongqing Medical University, Chongqing, China.
BMJ Open. 2024 Aug 17;14(8):e079715. doi: 10.1136/bmjopen-2023-079715.
This paper uses health economics methods to discuss the cost-effectiveness value of long protocol and antagonist protocol for in vitro fertilisation and embryo transfer (ET) in the Chinese population.
Health economic evaluation study.
The data needed to construct the model for this study were derived from published studies and other secondary sources in China.
No patients participated in the study.
The main outcomes were live birth rate (LBR) and cost. From the societal perspective, we considered the direct and indirect costs over the course of the treatment cycles. A cost-effectiveness was measured using the incremental cost-effectiveness ratio and the probability that a protocol has higher net monetary benefit. Sensitivity analysis was carried out to verify the reliability of the simulation results.
For the Chinese population, the long protocol resulted in a higher LBR than the antagonist protocol (29.33% vs 20.39%), but at the same time, it was more expensive (￥29 146.26 (US$4333.17) vs ￥23 343.70 (US$3470.51)), in the case of considering only one fresh ET cycle. It was the same when considering subsequent frozen ET (FET) cycles (51.78% vs 42.81%; ￥30 703.02 (US$4564.62) vs ￥24 740.95 (US$3678.24)). The results of most subgroups were consistent with the results of the basic analysis. However, for certain populations, the long protocol was the inferior protocol (less effective and more expensive).
For the Chinese population, when the monetary value per live birth was greater than ￥65 420 (US$9726) and ￥66 400 (US$9872), respectively, considering only one fresh cycle and considering subsequent frozen cycles, the long protocol is the preferred protocol. This threshold also varies for women of different ages and ovarian response capacities. For women in POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) group 2, group 3 and group 4, antagonist protocol is recommended as the preferred protocol. The results of this study need to be verified by further large-scale randomised controlled trials.
本文采用健康经济学方法，探讨了在中国人群中长方案和拮抗剂方案进行体外受精-胚胎移植（IVF-ET）的成本效果价值。
健康经济评估研究。
本研究模型所需的数据来源于中国发表的研究和其他二手资料。
无患者参与本研究。
主要结局指标为活产率（LBR）和成本。从社会角度考虑，我们考虑了治疗周期内的直接和间接成本。采用增量成本效果比和协议具有更高净货币收益的概率来衡量成本效果。进行敏感性分析以验证模拟结果的可靠性。
对于中国人群，长方案比拮抗剂方案的活产率更高（29.33%比 20.39%），但同时成本也更高（仅考虑一个新鲜胚胎移植周期时，￥29146.26（US$4333.17）比￥23343.70（US$3470.51）；考虑后续冷冻胚胎移植（FET）周期时，￥30703.02（US$4564.62）比￥24740.95（US$3678.24））。大多数亚组的结果与基础分析结果一致。然而，对于某些人群，长方案是劣效方案（效果较低，成本较高）。
对于中国人群，当每个活产的货币价值大于￥65420（US$9726）和￥66400（US$9872）时，仅考虑一个新鲜周期和后续冷冻周期，长方案是首选方案。这个阈值也因不同年龄和卵巢反应能力的女性而有所不同。对于 POSEIDON（患者导向策略涵盖个体化卵母细胞数）组 2、组 3 和组 4 的女性，推荐拮抗剂方案作为首选方案。本研究结果需要进一步的大规模随机对照试验来验证。
