Cost effectiveness modeling comparing recombinant FSH with urinary FSH for ovarian stimulation: a multinational evaluation

Abstract

Objective: The focus on cost containment imposed by shrinking national health care budgets is increasingly putting pressure on investigators to demonstrate that newer interventions are not only effective but also cost effective. In the area of assisted reproductive technology (ART) a shift in usage is occurring from urinary derived to biotechnology derived (recombinant) gonadotropins for ovarian stimulation. Provision of treatment with ART often involves several cycles of treatment, each associated with multiple steps with varying outcomes at each step. To take into account all the situations that are possible during the repeated cycles of treatment when trying to evaluate different ovarian stimulation regimens is a complex task that requires large numbers of subjects to adequately address the cost effectiveness of these therapies. A more efficient approach is to employ modeling techniques that can easily be applied to the different national health care systems. The objective of this study was to compare the cost-effectiveness of recombinant(r) FSH with urinary(u) FSH in the UK, USA, Germany and Spain. Design: The analyses used the Markov model and Montecarlo simulations taking into account the different health care environments in the four countries. For each nation, costs were provided by their national formulary and clinic tariff, and probabilities for outcomes were obtained from randomized controlled trials, the medical literature and national registries. Materials/Methods: The data were then validated by a panel of national experts and, because estimates for key clinical data vary depending on the source, the estimation of variability in the transition probabilities was also ratified by the panel. This approach provided a range of transitional probabilities from which a precise standard deviation could be obtained for each outcome. The final Markov matrix included 300/600 health states that represented the complete ART process over multiple cycles involving the transfer of fresh or cryopreserved embryos. Results: In the UK, the mean cost per pregnancy was Pd. St. 6060 for uFSH and Pd. St. 5906 for rFSH In USA, the mean cost per pregnancy was USD 47,096 for rFSH and USD 40,688 for rFSH. In Germany, the mean cost per pregnancy was Euro 23269 for uFSH and Euro 22144 for rFSH. In Spain, the mean cost per pregnancy was Euro 20565 for uFSH and Euro 19834 for rFSH. Conclusions: The studies confirmed that rFSH (GonalF) is more cost effective than uFSH for ovarian stimulation. The lower average cost per pregnancy was observed consistently in each country. Supported by: Serono International SA.