Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Reproductive Biology and Endocrinology
Published in: Reproductive Biology and Endocrinology 1/2018

Open Access 01-12-2018 | Research

Probabilistic cost-effectiveness analysis of controlled ovarian stimulation with recombinant FSH plus recombinant LH vs. human menopausal gonadotropin for women undergoing IVF

Authors: F. S. Mennini, A. Marcellusi, R. Viti, C. Bini, A. Carosso, A. Revelli, C. Benedetto

Published in: Reproductive Biology and Endocrinology | Issue 1/2018

Login to get access

Abstract

Background

The association of recombinant FSH plus recombinant LH in 2:1 ratio may be used not only to induce ovulation in anovulatory women with hypogonadotropic hypogonadism but also to achieve multiple follicular developments in human IVF. The aim of this analysis was to estimate the cost-effectiveness of Controlled Ovarian Stimulation (COS) with recombinant FSH (rFSH) plus recombinant LH (rLH) in comparison with highly purified human menopausal gonadotropin (HP-hMG) in the woman undergoing in vitro fertilization (IVF) in Italy.

Methods

A probabilistic decision tree was developed to simulate patients undergoing IVF, either using r-FSH + r-LH or HP-hMG to obtain COS. The model considers the National Health System (NHS) perspective and a time horizon equal to two years. Simulations were reported considering the number of retrieved oocytes (5–9, 10–15 and > 15) and transition probabilities were estimated through specific analyses carried out on the population of 848 women enrolled in the real-life.

Results

The model estimated that patients undertaking therapeutic protocol with r-FSH + r-LH increase the general success rate (+ 6.6% for pregnancy). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) of r-FSH + r-LH was below the willingness to pay set at €20,000 for all the considered scenarios.

Conclusions

The cost-utility analysis demonstrated that the r-FSH + r-LH is a cost-effective option for the Italian National Health System (NHS).
Literature
1.
Lunenfeld B. Historical perspectives in gonadotrophin therapy. Hum Reprod Update. 2004;10(6):453–67.CrossRefPubMed
2.
Loumaye E, Campbell R, Salat-Baroux J. Human follicle-stimulating hormone produced by recombinant DNA technology: a review for clinicians. Hum Reprod Update. 1995;1(2):188–99.CrossRefPubMed
3.
Hull M, et al. Recombinant human luteinising hormone: an effective new gonadotropin preparation. Lancet. 1994;344:334–5.CrossRefPubMed
4.
Baker VL, et al. Clinical efficacy of highly purified urinary FSH versus recombinant FSH in volunteers undergoing controlled ovarian stimulation for in vitro fertilization: a randomized, multicenter, investigator-blind trial. Fertil Steril. 2009;91(4):1005–11.CrossRefPubMed
5.
Shiraishi K, Matsuyama H. Gonadotoropin actions on spermatogenesis and hormonal therapies for spermatogenic disorders [review]. Endocr J. 2017;64(2):123–31.CrossRefPubMed
6.
Liu X, Hao C, Wang J. Efficacy of highly purified urinary FSH versus recombinant FSH in Chinese women over 37 years undergoing assisted reproductive techniques. International Journal of Fertility & Sterility. 2015;8(4):385–92.
7.
Daya S. Updated meta-analysis of recombinant follicle-stimulating hormone (FSH) versus urinary FSH for ovarian stimulation in assisted reproduction. Fertil Steril. 2002;77(4):711–4.CrossRefPubMed
8.
Andersen AN, Devroey P, Arce JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial. Hum Reprod. 2006;21(12):3217–27.CrossRefPubMed
9.
Hompes PG, et al. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients. Fertil Steril. 2008;89(6):1685–93.CrossRefPubMed
10.
Bosch E, et al. Highly purified hMG versus recombinant FSH in ovarian hyperstimulation with GnRH antagonists--a randomized study. Hum Reprod. 2008;23(10):2346–51.CrossRefPubMed
11.
Frydman R, Howles CM, Truong F. A double-blind, randomized study to compare recombinant human follicle stimulating hormone (FSH; Gonal-F) with highly purified urinary FSH (Metrodin) HP in women undergoing assisted reproductive techniques including intracytoplasmic sperm injection. The French Multicentre Trialists Human Reproduction. 2000;15(3):520–5.CrossRefPubMed
12.
Devroey P, et al. A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer. Fertil Steril. 2012;97(3):561–71.CrossRefPubMed
13.
van Wely M, et al. Effectiveness of human menopausal gonadotropin versus recombinant follicle-stimulating hormone for controlled ovarian hyperstimulation in assisted reproductive cycles: a meta-analysis. Fertil Steril. 2003;80(5):1086–93.CrossRefPubMed
14.
Papaleo E, et al. Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women. Ther Clin Risk Manag. 2014;10:479–84.PubMedPubMedCentral
15.
Moro F, et al. Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women >/=35 years: a RCT. Hum Reprod. 2015;30(1):179–85.CrossRefPubMed
16.
Pacchiarotti A, et al. Urinary hMG (Meropur) versus recombinant FSH plus recombinant LH (Pergoveris) in IVF: a multicenter, prospective, randomized controlled trial. Fertil Steril. 2010;94(6):2467–9.CrossRefPubMed
17.
Revelli R, et al. Controlled ovarian stimulation with recombinant-FSH plus recombinant-LH vs. human menopausal gonadotropin based on the number of retrieved oocytes: results from a routine clinical practice in a real-life population. Reprod Biol Endocrinol. 2015;13:77.CrossRefPubMedPubMedCentral
18.
Berg Brigham K, Cadier B, Chevreul K. The diversity of regulation and public financing of IVF in Europe and its impact on utilization. Hum Reprod. 2013;28(3):666–75.CrossRefPubMed
19.
Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation. N Y: O.U.P. Inc; 2007.
20.
Decreto del Ministero della Salute 18 ottobre 2012, Tariffe delle prestazioni di assistenza ospedaliera per acuti. Gazzetta Ufficiale n. 23 del 28 gennaio 2013.
21.
Patel RR, Albert TJ, Rihn JA. Cost-effectiveness, QALYs, and incremental cost-effectiveness ratios. Seminars in Spine Surgery. 2014;26:2–7.CrossRef
22.
23.
Patrick DL, Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. N Y: O.U. Press; 1993.
24.
Drummond, M.F., et al., Methods for the Economic Evaluation of Health Care Programmes. 2nd ed. ed, ed. O.M. Publications. 1997, Oxford.
25.
Wouters OJ, Naci H, Samani NJ. QALYs in cost-effectiveness analysis: an overview for cardiologists. Heart. 2015;101(23):1868–73.CrossRefPubMed
26.
Sunkara SK, et al. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26(7):1768–74.CrossRefPubMed
27.
Metadata
Title
Probabilistic cost-effectiveness analysis of controlled ovarian stimulation with recombinant FSH plus recombinant LH vs. human menopausal gonadotropin for women undergoing IVF
Authors
F. S. Mennini
A. Marcellusi
R. Viti
C. Bini
A. Carosso
A. Revelli
C. Benedetto
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2018
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-018-0386-2

Other articles of this Issue 1/2018

Reproductive Biology and Endocrinology 1/2018 Go to the issue

Research

Endometrium metabolomic profiling reveals potential biomarkers for diagnosis of endometriosis at minimal-mild stages

Research

Trophoblast differentiation, invasion and hormone secretion in a three-dimensional in vitro implantation model with rhesus monkey embryos

Review

Open versus closed vitrification system of human oocytes and embryos: a systematic review and meta-analysis of embryologic and clinical outcomes

Research

The thermo-sensitive gene expression signatures of spermatogenesis

Research

The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome

Research

Dysregulated erythropoietin-producing hepatocellular receptor A2 (EphA2) is involved in tubal pregnancy via regulating cell adhesion of the Fallopian tube epithelial cells