Poulsen PB, Ingerslev HJ, Larsen DD, Hojgaard A; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 51.
Health Economics, Institute of Public Health, University of Southern Denmark, Main Camp: Odense University, Odense, Denmark.
Tradionally In-Vitro Fertilization (IVF) is carried out with full hormone stimulation (GnRHa+FSH). Advantages are a high rate of pregnancies per cycle started, whereas disadvantages are side-effects and a high risk of multiple pregnancies. An alternative is a clomiphene citrate stimulated IVF, which, due to less hormone stimulation and fewer oocytes retrieved, results in very few multiple pregnancies. PURPOSE: To compare the cost-effectiveness of a hormone stimulated IVF versus a clomiphene citrate IVF. As part of a health technology assessment this will reveal whether clomiphene citrate IVF should be offered in Denmark. The study is financed by the Danish Institute for Health Technology Assessment. METHODS: In a clinical trial 68 infertile couples attending the Clinic of Fertilization at Aarhus University Hospital, Skejby, in 1997-98 received clomiphene citrate IVF and were compared with normal IVF protocol (GnRHa+FSH). Criteria of inclusion were: women<35 years and men with normal sperm quality. Based on these criteria, a historical cohort of 147 infertile couples (1996-98) receiving full hormone stimulated IVF were retrieved as well. Unit costs (salary, materials, capital outlay and overhead) are estimated in detail by the use of activity-based costing methods, e.g. time studies. Furthermore, other hospital costs associated with abortion, delivery and neonatal care and societal costs resulting from the production lost in society due to fertilization are estimated. Measures of effectiveness chosen are the number of clinical pregnancies per cycle started and the accumulated number within three cycles. RESULTS: The unit costs estimated in the study showed to be three times higher for hormone stimulated IVF compared with clomiphene citrate IVF, which was mainly explained by the hormone used. The effectiveness of the two protocols were the same in terms of clinical pregnancies per transfer (34% vs. 36%) but not per started cycle (28% vs. 19%). However, hormone stimulated IVF resulted in a high number of twins that generated an extra resource consumption for neonatal care. Neonatal care costs were estimated to be DKK 36.500 per IVF-born child resulting from a multiple pregnancy. CONCLUSIONS: The results of this cost-effectiveness analysis show a trade-off between the costs and the effectiveness of the two IVF treatments. However, clomiphene citrate IVF may be a relevant option for selected infertile couples.
Publication Types:
Keywords:
- Child
- Clomiphene
- Denmark
- Female
- Fertilization in Vitro
- Follicle Stimulating Hormone
- Hormone Antagonists
- Humans
- Infertility
- Infertility, Female
- Male
- Oocytes
- Pregnancy
- Pregnancy Outcome
- Pregnancy, Multiple
- Twins
- hsrmtgs
Other ID:
UI: 102193784
From Meeting Abstracts