Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

Autor: Harold R. Verhoeve, M.J.C. Eijkemans, Jesper M. J. Smeenk, Carolien A.M. Koks, G.J.E. Oosterhuis, Denise A. M. Perquin, R. van Golde, Judith Gianotten, Frank J.M. Broekmans, Sjoerd Repping, Patrick M.M. Bossuyt, J. W. M. Maas, M. D. A. Lambers, B. J. Cohlen, M. J. Pelinck, Henk Groen, F. van der Veen, Els Slappendel, Annemieke Hoek, Peter G.A. Hompes, P. F. van Bommel, M. van Wely, J.P. de Bruin, Diederik A. Hoozemans, R. I. Tjon-Kon-Fat, A.J. Bensdorp, Ben W.J. Mol
Přispěvatelé: Reproductive Origins of Adult Health and Disease (ROAHD), Methods in Medicines evaluation & Outcomes research (M2O), Value, Affordability and Sustainability (VALUE), Obstetrics and gynaecology, ICaR - Ischemia and repair, RS: GROW - Developmental Biology, RS: GROW - R4 - Reproductive and Perinatal Medicine, Afdeling Onderwijs FHML, MUMC+: HVC Pieken Trombose (9), MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, Promovendi PHPC, Psychiatrie en Neuropsychologie, Graduate School, Obstetrics and Gynaecology, APH - Amsterdam Public Health, 10 Public Health & Methodologie, Other departments, ARD - Amsterdam Reproduction and Development, Center for Reproductive Medicine
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Male
STIMULATION
Intrauterine insemination
Pregnancy Rate
Cost effectiveness
Cost-Benefit Analysis
medicine.medical_treatment
Controlled ovarian hyperstimulation
single embryo transfer
law.invention
Randomized controlled trial
Pregnancy
law
In vitro fertilization
Obstetrics and Gynaecology
US HEALTH-CARE
Medicine
Non-U.S. Gov't
Insemination
Artificial
Netherlands
Unexplained infertility
Obstetrics
Research Support
Non-U.S. Gov't
Rehabilitation
INTRAUTERINE INSEMINATION
Pregnancy Outcome
Obstetrics and Gynecology
RANDOMIZED CONTROLLED-TRIAL
Prognosis
Embryo transfer
Models
Economic
Randomized Controlled Trial
MODIFIED NATURAL CYCLE
Female
MILD MALE SUBFERTILITY
in vitro fertilization
Adult
medicine.medical_specialty
Modified natural cycle
Fertilization in Vitro
Research Support
Ovulation Induction
Journal Article
Humans
SINGLE-EMBRYO-TRANSFER
cost-effectiveness
Infertility
Male
Cryopreservation
In vitro fertilisation
Single embryo transfer
business.industry
MULTIPLE PREGNANCIES
Embryo Transfer
Pregnancy rate
PREGNANCY RATES
Reproductive Medicine
Fertilization
Ovulation induction
Cost-effectiveness
business
IN-VITRO FERTILIZATION
Zdroj: Human Reproduction, 30(10), 2331-2339. Oxford University Press
Human Reproduction, 30(10), 2331. Oxford University Press
Tjon-Kon-Fat, R I, Bensdorp, A J, Bossuyt, P M M, Koks, C, Oosterhuis, G J E, van Hoek, A, Hompes, P, Broekmans, F J, Verhoeve, H R, de Bruin, J P, van Golde, R, Repping, S, Cohlen, B J, Lambers, M D A, van Bommel, P F, Slappendel, E, Perquin, D, Smeenk, J, Pelinck, M J, Gianotten, J, Hoozemans, D A, Maas, J W M, Groen, H, Eijkemans, M J C, van der Veen, F, Mol, B W J & van Wely, M 2015, ' Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation? ', Human Reproduction, vol. 30, no. 10, pp. 2331-2339 . https://doi.org/10.1093/humrep/dev193
Human reproduction (Oxford, England), 30(10), 2331-2339. Oxford University Press
ISSN: 0268-1161
DOI: 10.1093/humrep/dev193
Popis: STUDY QUESTION: What is the cost-effectiveness of in vitro fertilization(IVF) with conventional ovarian stimulation, single embryotransfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) as a first-line treatment in couples with unexplained subfertility and an unfavourable prognosis on natural conception?.SUMMARY ANSWER: Both IVF strategies are significantly more expensive when compared with IUI-COH, without being significantly more effective. In the comparison between IVF-MNC and IUI-COH, the latter is the dominant strategy. Whether IVF-SET is cost-effective depends on society's willingness to pay for an additional healthy child.WHAT IS KNOWN ALREADY: IUI-COH and IVF, either after conventional ovarian stimulation or in a MNC, are used as first-line treatments for couples with unexplained or mild male subfertility. As IUI-COH is less invasive, this treatment is usually offered before proceeding to IVF. Yet, as conventional IVF with SET may lead to higher pregnancy rates in fewer cycles for a lower multiple pregnancy rate, some have argued to start with IVF instead of IUI-COH. In addition, IVF in the MNC is considered to be a more patient friendly and less costly form of IVF.STUDY DESIGN, SIZE, DURATION: We performed a cost-effectiveness analysis alongside a randomized noninferiority trial. Between January 2009 and February 2012, 602 couples with unexplained infertility and a poor prognosis on natural conception were allocated to three cycles of IVF-SET including frozen embryo transfers, six cycles of IVF-MNC or six cycles of IUI-COH. These couples were followed until 12 months after randomization.PARTICIPANTS/MATERIALS, SETTING, METHODS: We collected data on resource use related to treatment, medication and pregnancy from the case report forms. We calculated unit costs from various sources. For each of the three strategies, we calculated the mean costs and effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated for IVF-SET compared with IUI-COH and for IVF-MNC compared with IUI-COH. Nonparametric bootstrap resampling was used to investigate the effect of uncertainty in our estimates.MAIN RESULTS AND THE ROLE OF CHANCE: There were 104 healthy children (52%) born in the IVF-SET group, 83 (43%) the IVF-MNC group and 97 (47%) in the IUI-COH group. The mean costs per couple were (sic)7187 for IVF-SET, (sic)8206 for IVF-MNC and (sic)5070 for IUI-COH. Compared with IUI-COH, the costs for IVF-SET and IVF-MNC were significantly higher (mean differences (sic)2117; 95% CI: (sic)1544-(sic)2657 and (sic)3136, 95% CI: (sic)2519-(sic)3754, respectively). The ICER for IVF-SET compared with IUI-COH was (sic)43 375 for the birth of an additional healthy child. In the comparison of IVF-MNC to IUI-COH, the latter was the dominant strategy, i.e. more effective at lower costs.LIMITATIONS, REASONS FOR CAUTION: We only report on direct health care costs. The present analysis is limited to 12 months.WIDER IMPLICATIONS OF THE FINDINGS: Since we found no evidence in support of offering IVF as a first-line strategy in couples with unexplained and mild subfertility, IUI-COH should remain the treatment of first choice.
Databáze: OpenAIRE
Externí odkaz: