ECONOMIC EVALUATION OF IN-VITRO FERTILIZATION AS ASSISTED REPRODUCTIVE TECHNIQUE IN MANAGEMENT OF INFERTILITY IN THE NETHERLANDS- A COST-EFFECTIVENESS MODEL BASED ON A LONG DOWN-REGULATION PROTOCOL
Author(s)
Fragoulakis V1, Pescott C2, Maniadakis N1
1National School of Public Health, Athens, Greece, 2Merck BV, Schiphol-Rijk, The Netherlands
OBJECTIVES: To conduct an economic evaluation comparing a recombinant gonadotrophin (r-hFSH, follitropin alfa, GONAL-f) with two classes of urinary gonadotrophins, hp-HMG (Menopur) and u-FSH (Fostimon) for ovarian stimulation in women undergoing in-vitro fertilization (IVF) treatment in The Netherlands METHODS: A pharmaco-economic model was developed, simulating each step in IVF protocol from start of therapy until either live birth, new IVF treatment cycle, or stopping IVF, following a long down-regulation protocol. A decision tree combined with a Markov model details progress through each health state, including oocyte retrieval, fresh embryo transfer, up to two subsequent cryo-embryo transfers, and (ongoing) pregnancy or miscarriage. A health insurer perspective was chosen and the time horizon was set to a maximum of three consecutive treatment cycles. Transition probabilities and costing data were derived from a real-world observational outcomes database (Germany), and official tariff lists (The Netherlands). Adverse events were considered equal amongst comparators and therefore excluded. The model was validated by clinical experts to ensure appropriateness and to local management of infertility and applicability. A Monte Carlo simulation with 5,000 iterations was undertaken for each strategy to explore uncertainty and to construct uncertainty intervals (UI). RESULTS: Mean total treatment costs were estimated as: €5,664 for GONAL-f (95%UI: €5,167-€6,151), €5,990 for Menopur (95%UI: €5,498-€6,488) and €5,760 for Fostimon (95%UI: €5,256-€6,246). The probability of a live birth was estimated at 36.1% (95%UI: 27.4%-44.3%), 33.9% (95%UI: 26.2%-41.5%) and 34.1% (95%UI: 25.9%-41.8%) for GONAL-f, Menopur and Fostimon respectively. Costs per live birth estimates are: €15,674 (GONAL-f), €16,878 (Fostimon) and €17,636 (Menopur). Probabilistic sensitivity analysis indicates a probability of 72.5% that GONAL-f is cost-effective at a willingness-to-pay of € 20,000/live birth. Probabilistic results remained constant under several analyses. CONCLUSIONS: GONAL-f appears to be cost-effective compared to the most prominent comparators in management of infertility in The Netherlands.
Conference/Value in Health Info
2014-05, ISPOR 2014, Palais des Congres de Montreal
Value in Health, Vol. 17, No. 3 (May 2014)
Code
PIH32
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Reproductive and Sexual Health