Background Controlled ovarian hyperstimulation (COH) is mainly based on management of follicle-stimulating hormone (FSH). FSH may be obtained from the urine of menopausal women (u-FSH) or through recombinant biotechnology (r-FSH).
Purpose To conduct a pharmacoeconomic evaluation of different FSH (u-FSH vs. r-FSH) in COH.
Materials and Methods We conducted a bibliographic review to compare the efficacy of u-FSH and r-FSH in COH (Database: PubMed, keywords: FSH and COH, randomised and controlled clinical trials, from 2005 to 2011). The efficacy indicators were: progression rate in pregnancy (pregnancy remained at 12 weeks) and the number of mature oocytes obtained. We determined the cost per unit of efficacy (using current Spanish drug prices in 2012) and the incremental cost-efficacy ratio (ICER) with their sensitivity analysis. Setting: Assisted Reproduction unit in tertiary teaching hospital that serves an average of 340 patients per year. Statistical analysis powered by SPSS 15.0.
Results We analysed 10 clinical trials in women being treated with COH. The pooled data of the progression of pregnancy was 26.2% (FSH-r) vs. 22.3% (FSH-u) (difference = 3.9%; 95% CI = 1.2–5.9), and the average number of mature oocytes was: 9.0 (FSH-r) vs. 7.1 (FSH-u) (difference = 1.9; 95% CI = 0.7 to 4.1). The cost per pregnancy for r-FSH was €2,832.3 (€1,628.2–€3,754.3) and €2,332.5 (€1,526,1–€2,884.7) for u-FSH, so that the ICER in the pregnancy rate was 128.1 (85.1–147.4). The cost per number of mature oocytes obtained for r-FSH was €82.3 (€78.3–€98.1) and €73.3 (€67.6–€81.7) for u-FSH, so the ICER in mature oocytes obtained was 4.7 (4.0–15.2).
Conclusions According to scientific evidence r-FSH appears to be more effective in women undergoing COH; however, this slight increase in efficacy does not seem to compensate for the difference in price, the result being that u-FSH is more cost effective.
No conflict of interest.
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