OBJECTIVES:

This literature review aims to describe the current landscape of cost-effectiveness of approved fertility agents in North America and European countries, identifying the evaluation inputs, assumptions, and major findings of these evaluations as well as summarizing the variability of these findings and conclusions.

METHODS:

Investigators elected to resource MEDLINE® OVID and Web of Science search engines to identify economic evaluations of approved infertility agents published between 2002 to 2022. The selected studies included those focused on non-menopausal females, evaluating the use of at least one approved pharmacologic fertility agent with the intention of treating fertility challenges, and providing findings or recommendations. Two independent reviewers screened each abstract and full-text article against inclusion/exclusion criteria and completed data extraction in a similar fashion. Data from each study was collected with respect to the type of study design, inputs (variables and costs), assumptions, findings, and recommendations.

RESULTS:

This investigation revealed 649 articles, of which 32 economic evaluations met our selection criteria. Six (19%) of these studies analyzed United States cost and effectiveness data, while 26 (81%) utilized European data. Greater than 60 percent of the studies had a health system or payer perspective and only included direct treatment costs in their analysis. The majority of pharmacologic interventions evaluated were human gonadotropin hormones, clomiphene citrate (CC), and progesterone. This investigation identified a trend to evaluate cost-effectiveness of gonadotropins; the findings of these studies were in favor of urinary FSH and highly purified FSH compared to recombinant FSH and CC.

CONCLUSIONS:

This investigation looked to describe the current landscape of cost-effective analyses in fertility medicine and identify major themes in these analyses with respect to their inputs, assumptions, and findings. Investigators assert a need for further economic evaluations in fertility medicine as well as development of best practices.