Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis.

Autor: Danhof NA; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands., van Wely M; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands., Repping S; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands., van der Ham DP; Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands., Klijn N; Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands., Janssen ICAH; Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands., Rijn-van Weert JM; Department of Obstetrics and Gynaecology, NoordWest Groep Alkmaar, Alkmaar, the Netherlands., Twisk M; Department of Obstetrics and Gynaecology, MC Zuiderzee, Lelystad, the Netherlands., Traas MAF; Department of Obstetrics and Gynaecology, Gelre Hospital, Apeldoorn, the Netherlands., Pelinck MJ; Department of Obstetrics and Gynaecology, Scheper Hospital, Emmen, the Netherlands., Perquin DAM; Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands., Boks DES; Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, the Netherlands., Sluijmer A; Department of Obstetrics and Gynaecology, Wilhelmina Hospital, Assen, the Netherlands., Mol BWJ; Monash University, Monash Medical Centre, Clayton Victoria, Australia., van der Veen F; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands., Mochtar MH; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands. Electronic address: m.h.mochtar@amc.uva.nl.
Jazyk: angličtina
Zdroj: Reproductive biomedicine online [Reprod Biomed Online] 2020 Jan; Vol. 40 (1), pp. 99-104. Date of Electronic Publication: 2019 Sep 16.
DOI: 10.1016/j.rbmo.2019.09.004
Abstrakt: Research Question: What is the cost-effectiveness of gonadotrophins compared with clomiphene citrate in couples with unexplained subfertility undergoing intrauterine insemination (IUI) with ovarian stimulation under strict cancellation criteria?
Design: A cost-effectiveness analysis alongside a randomized controlled trial (RCT). Between July 2013 and March 2016, 738 couples were randomized to gonadotrophins (369) or clomiphene citrate (369) in a multicentre RCT in the Netherlands. The direct medical costs of both strategies were compared. Direct medical costs included costs of medication, cycle monitoring, insemination and, if applicable, pregnancy monitoring. Non-parametric bootstrap resampling was used to investigate the effect of uncertainty in estimates. The cost-effectiveness analysis was performed according to intention-to-treat. The incremental cost-effectiveness ratio (ICER) between gonadotrophins and clomiphene citrate for ongoing pregnancy and live birth was assessed.
Results: The mean costs per couple were €1534 for gonadotrophins and €1067 for clomiphene citrate (mean difference of €468; 95% confidence interval [CI] €464-472). As ongoing pregnancy rates were 31% in women allocated to gonadotrophins and 26% in women allocated to clomiphene citrate (relative risk 1.16, 95% CI 0.93-1.47), the ICER was €21,804 (95% CI €11,628-31,980) per additional ongoing pregnancy with gonadotrophins and €17,044 (95% CI €8998-25,090) per additional live birth with gonadotrophins.
Conclusions: Gonadotrophins are more expensive compared with clomiphene citrate in couples with unexplained subfertility undergoing IUI with adherence to strict cancellation criteria, without being significantly more effective.
(Copyright © 2019. Published by Elsevier Ltd.)
Databáze: MEDLINE
Externí odkaz: