Recombinant or urinary follicle-stimulating hormone? A cost-effectiveness analysis derived by particularizing the number needed to treat from a published meta-analysis

Abstract

Objective: To demonstrate that particularizing pooled results of a meta-analysis can derive incremental cost effectiveness of superovulation with recombinant follicle-stimulating hormones (rFSH) vs. the highly purified urinary form (uFSH) for assisted conception. Design: A retrospective study. Setting: An assisted conception unit in the United Kingdom. Patient(s): One hundred forty-five fresh in vitro fertilization (IVF) and 58 fresh intracytoplasmic sperm injection (ICSI) cycles. Intervention(s): rFSH vs. uFSH. Main Outcome Measure(s): Incremental cost-effectiveness (i.e., cost needed to treat, or CNT) and budget-impact analyses of rFSH vs. uFSH. Result(s): In women less than 30 years old, the clinical pregnancy rate was 37.7% (95% CI 24.8%–52.1%), the particularized number needed to treat (pNNT) was −19, and the cost needed to treat was £5070.51 (£3660.53 to £7619.32). For the 30- to 35-year-old age group, the clinical pregnancy rate was 29.9% (95% CI 20.0%–41.4%), the particularized number needed to treat was −24, and CNT was £7335.59 (£5284.11 to £10,941.22). For the 36- to 40-year-old age group, the clinical pregnancy rate was 30.6.0% (95% CI 19.6%–43.7%), the particularized number needed to treat was −23.0, and the CNT was £8569.67 (£5998.70 to £13,413.24). Conclusion(s): The CNT and thus the budget impact analyses (the extra number of cycles that can be funded by the CNT) both increase directly with age of the patient, and inversely with the clinical pregnancy rate.