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Hum. Reprod. Advance Access originally published online on November 22, 2007
Human Reproduction 2008 23(2):316-323; doi:10.1093/humrep/dem372
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint

S. Polinder1,3, E.M.E.W. Heijnen2, N.S. Macklon2, J.D.F. Habbema1, B.J.C.M. Fauser1 and M.J.C. Eijkemans1,2

1 Department of Public Health, Erasmus Medical Center, Dr Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands 2 Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

3 Correspondence address. E-mail: s.polinder{at}erasmusmc.nl

BACKGROUND: Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF.

METHODS: Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. The main outcome measures are total costs of treatment within a 12 months period after randomization, and the relationship between total costs and proportion of cumulative pregnancies resulting in term live birth within 1 year of randomization.

RESULTS: Despite a significantly increased average number of IVF cycles (2.3 versus 1.7; P < 0.001), lower average total costs over a 12-month period (8333 versus {euro}10 745; P = 0.006) were observed using the mild strategy. This was mainly due to higher costs of the obstetric and post-natal period for the standard strategy, related to multiple pregnancies. The costs per pregnancy leading to term live birth were {euro}19 156 in the mild strategy and {euro}24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was {euro}185 000 per extra pregnancy leading to term live birth.

CONCLUSIONS: Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.

Key words: GnRH antagonist/mild ovarian stimulation/single embryo transfer/IVF

Submitted on February 23, 2007; resubmitted on October 11, 2007; accepted on October 23, 2007.


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