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

Autor: MJ Pelinck, M. Twisk, Madelon van Wely, Dominique E.S. Boks, Noor A. Danhof, Monique H. Mochtar, David P. van der Ham, Ben W.J. Mol, Janne Meije Rijn-van Weert, Nicole F. Klijn, Sjoerd Repping, Ineke C. A. H. Janssen, Fulco van der Veen, Maaike A. F. Traas, Denise A. M. Perquin, Alexander V. Sluijmer
Přispěvatelé: APH - Personalized Medicine, APH - Methodology, ARD - Amsterdam Reproduction and Development, Center for Reproductive Medicine
Rok vydání: 2020
Předmět:
0301 basic medicine
Adult
Male
medicine.medical_specialty
Intrauterine insemination
Cost effectiveness
Cost-Benefit Analysis
Fertilization in Vitro
Insemination
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
law.invention
Clomiphene
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
Randomized controlled trial
Ovulation Induction
law
Pregnancy
medicine
Humans
Insemination
Artificial
health care economics and organizations
Unexplained infertility
030219 obstetrics & reproductive medicine
Obstetrics
business.industry
Gonadotrophins
Obstetrics and Gynecology
Subfertility
Clomiphene citrate
Cost-effectiveness analysis
medicine.disease
030104 developmental biology
Treatment Outcome
Reproductive Medicine
Relative risk
Infertility
Female
Cost-effectiveness
Live birth
business
Gonadotropins
Developmental Biology
Zdroj: Reproductive Biomedicine Online, 40, 99-104
Reproductive biomedicine online, 40(1), 99-104. Elsevier
Reproductive Biomedicine Online, 40, 1, pp. 99-104
ISSN: 1472-6483
Popis: 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.
Databáze: OpenAIRE
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