Hum. Reprod. Advance Access originally published online on November 22, 2007
Human Reproduction 2008 23(2):316-323; doi:10.1093/humrep/dem372
Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint
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 
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 19 156 in the mild strategy and 24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was 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.