Abstract
Purpose: To compare the strategy for mild stimulation IVF versus conventional stimulation IVF. Methods: A decision tree analytic model was created to compare IVF with mild stimulation versus convention stimulation in infertile women <38 years of age to evaluate which strategy is the least costly per live birth. Results: Using base-case estimates of costs and probabilities in women <38 years old with unexplained infertility, the cumulative live birth rate in the mild versus conventional stimulation group was 15.8% versus 28.6%, respectively. The average cost for mild and convention IVF was $8789 and $14,364 per arm, respectively. In base case analysis, the ICER was $43,516 representing the additional cost per live birth with conventional IVF. One-way sensitivity analysis evaluated the robustness of the data and revealed a tradeoff in which mild IVF stimulation had lower total costs and also lower live births versus conventional stimulation. Conclusions: Mild stimulation IVF has a lower cost per cycle but is also associated with lower live birth rates. Patient care decisions should be individualized irrespective of cost.
Highlights
The introduction of in vitro fertilization (IVF) dramatically improved the ability to help women with unexplained infertility achieve a pregnancy [1] [2]
The mild-IVF arm had a lower percentage of live births and lower total costs
Using one-way sensitivity analysis for each input variable, the model was sensitive to changes in live birth rate (LBR) after IVF (Table 3)
Summary
The introduction of in vitro fertilization (IVF) dramatically improved the ability to help women with unexplained infertility achieve a pregnancy [1] [2]. (2016) Mild Stimulation versus Conventional IVF: A Cost-Effectiveness Evaluation. Mild ovarian stimulation has potential advantages over conv-IVF in select patient populations. Due to decreases in follicular number and retrieved oocytes, mild-IVF has been associated with a decrease in the risk of OHSS and multiple pregnancy rates [5]-[10]. The less pronounced hormonal elevations seen with mildIVF may be associated with an improvement in endometrial receptivity, potentially less risk of aneuploidy, and an improvement in obstetrical outcomes [11]-[13]. Patient preference is important, as the psychological demands and the total cost per cycle appear to be less with mild-IVF as compared to conv-IVF [5] [14]-[16]
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