Human Reproduction, Vol. 16, No. 12, 2563-2569,
December 2001
© 2001 European Society of Human Reproduction and Embryology
Cost-effectiveness modelling of recombinant FSH versus urinary FSH in assisted reproduction techniques in the UK
1 McMaster University, Hamilton Ontario, Canada, 2 University of Sheffield, The Jessop Hospital for Women, Sheffield, UK, 3 National Center of Scientific Research (CNRS), Villeurbanne, France, 4 Texas Fertility Center, Austin, Texas, USA, 5 Carlanderska Hospital, Gothenburg, Sweden, 6 IWK Grace Health Center, Halifax University, Canada and 7 Serono International SA, Geneva, Switzerland
BACKGROUND: The purpose of this study was to undertake an economic evaluation to compare the cost-effectiveness of recombinant (r)FSH with urinary (u)FSH for attaining clinical pregnancy with assisted reproduction. METHODS: Mathematical modelling was utilized incorporating a Markovian decision framework and a Monte Carlo simulation. Statistical representations of recurrent events over time were incorporated into a decision analysis involving fresh and frozen cycles in any sequence (after the first fresh embryo transfer cycle) over three successive assisted reproduction attempts. The mean values of transition probabilities were derived from randomized controlled clinical trials and published reports. The distributions of these transition probabilities were agreed upon by a panel of experts. Cost data for procedures and drugs were derived and validated according to the perspectives of the National Health Service and private clinics in the UK. RESULTS: The study involved 5000 Monte-Carlo simulations of treatment on a Markov cohort of 100 000 patients. The total number of pregnancies attained was significantly higher in the rFSH (40 575) compared with the uFSH (37 358) group. The cost per successful pregnancy was significantly lower for rFSH (£5906) compared with uFSH (£6060) and overall, fewer cycles of treatment were required with rFSH to achieve an ongoing pregnancy. The incremental cost-effectiveness ratio is £4148 for each additional clinical pregnancy with rFSH. CONCLUSIONS: In addition to the increased effectiveness of rFSH in ART, this study demonstrated that it is more cost-effective and more efficient than uFSH in attaining an ongoing pregnancy.
Key words: assisted reproduction/cost-effectiveness/mathematical modelling/recombinant FSH/urinary FSH
8 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, McMaster University,1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. E-mail: dayas{at}mcmaster.ca
* Colin Howles is Vice President, Reproductive Endocrinology, Serono, International SA and Ariel Beresniak is Corporate Director Pharmacoeconomics, Serono International, SA.
Submitted on December 29, 2000; July 10, 2001
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