Cost-effectiveness Analysis of GnRH Antagonist Protocol and Short-acting GnRH Agonist Long Protocol in Fresh Embryo Transfer Based on Propensity Score Matching
Background In the field of assisted reproductive technology, medical cost of patients is increasingly considered as an important reference for making treatment protocols, while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and short-acting GnRH agonist (GnRH-a) long protocol in fresh embryo transfer. Objective To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching (PSM) . Methods A total of 1 971 patients treated with 2 117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1 549 patients with 1 685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation (COH). Baseline data 〔including female age, type and duration of infertility, BMI, age at menarche, number of pregnancies, follicle stimulating hormone (FSH), basal estradiol (E2), basal luteinizing hormone (LH), basal progesterone, antral follicle count (AFC), etc.〕, therapeutic indicators 〔including COH protocols, gonadotropin (Gn) durarion, total Gn dosage, E2, LH, progesterone level and endometrial thickness on the trigger day, number of retrieved and mature oocytes, fertilization methods, number of transferable embryos, high-quality embryos and transferred embryos, etc.〕 and the clinical outcomes〔including unpregnancy, miscarriage, ectopic gestation, live birth (LB) 〕 were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2. Cost-effectiveness analysis was performed on the two groups after PSM, sensitivity analysis was applied to verify the robustness of the study findings. Results There were significant differences in female age, BMI, basal FSH, LH, and AFC between the two groups before PSM (P<0.05). A total of 390 cycles were included in each group after PSM, and there was no significant difference in female age, BMI, basal FSH, LH, and AFC between the two groups after PSM (P>0.05). Therapeutic indicators including Gn duration, Gn dosage, E2 and endometrial thickness on the trigger day, number of retrieved and mature oocytes were lower in the GnRH-ant group than GnRH-a group, while LH level on the trigger day was higher in the GnRH-ant than the GnRH-a group (P<0.05) after PSM. Clinical outcomes including clinical pregnancy rate (43.08% vs. 54.62%, P=0.001), implantation rate (29.15% vs. 37.01%, P=0.001), and LB rate (33.59% vs. 44.10%, P=0.003) were significantly lower in the GnRH-ant group than GnRH-a group after PSM. The cost of ovulation induction drug per cycle and total cost per cycle were lower in the GnRH-ant group than the GnRH-a group after PSM (P<0.05). Using LB rate as the endpoint indicator, cost-effectiveness analysis showed that the cost per LB was 66 397.92 and 54 226.33 yuan in the GnRH-ant group and GnRH-a group, respectively. The incremental cost-effectiveness ratio was 15 325.88 yuan, less than 1 time of per capita GDP in China in 2018 (64 644 yuan). The results of sensitivity analysis were consistent with the results of the basic analysis. Conclusion In fresh embryo transfer cycles, the clinical outcomes and economy performances of GnRH-a protocol are superior to GnRH-ant protocol..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Zhongguo quanke yixue - 26(2023), 30, Seite 3809-3814 |
| Sprache: |
Chinesisch |
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| Beteiligte Personen: |
HUANG Taishuai, CHI Yan, HE Ping, HUANG Guolan, ZUO Yanli [VerfasserIn] |
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| Links: |
doi.org [kostenfrei] |
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| Themen: |
Infertility, female|embryo transfer|ovulation induction|clinical pregnancy|live birth rate|cost-effectiveness analysis|propensity score matching |
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| doi: |
10.12114/j.issn.1007-9572.2022.0871 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
DOAJ091487471 |
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| 520 | |a Background In the field of assisted reproductive technology, medical cost of patients is increasingly considered as an important reference for making treatment protocols, while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and short-acting GnRH agonist (GnRH-a) long protocol in fresh embryo transfer. Objective To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching (PSM) . Methods A total of 1 971 patients treated with 2 117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1 549 patients with 1 685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation (COH). Baseline data 〔including female age, type and duration of infertility, BMI, age at menarche, number of pregnancies, follicle stimulating hormone (FSH), basal estradiol (E2), basal luteinizing hormone (LH), basal progesterone, antral follicle count (AFC), etc.〕, therapeutic indicators 〔including COH protocols, gonadotropin (Gn) durarion, total Gn dosage, E2, LH, progesterone level and endometrial thickness on the trigger day, number of retrieved and mature oocytes, fertilization methods, number of transferable embryos, high-quality embryos and transferred embryos, etc.〕 and the clinical outcomes〔including unpregnancy, miscarriage, ectopic gestation, live birth (LB) 〕 were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2. Cost-effectiveness analysis was performed on the two groups after PSM, sensitivity analysis was applied to verify the robustness of the study findings. Results There were significant differences in female age, BMI, basal FSH, LH, and AFC between the two groups before PSM (P<0.05). A total of 390 cycles were included in each group after PSM, and there was no significant difference in female age, BMI, basal FSH, LH, and AFC between the two groups after PSM (P>0.05). Therapeutic indicators including Gn duration, Gn dosage, E2 and endometrial thickness on the trigger day, number of retrieved and mature oocytes were lower in the GnRH-ant group than GnRH-a group, while LH level on the trigger day was higher in the GnRH-ant than the GnRH-a group (P<0.05) after PSM. Clinical outcomes including clinical pregnancy rate (43.08% vs. 54.62%, P=0.001), implantation rate (29.15% vs. 37.01%, P=0.001), and LB rate (33.59% vs. 44.10%, P=0.003) were significantly lower in the GnRH-ant group than GnRH-a group after PSM. The cost of ovulation induction drug per cycle and total cost per cycle were lower in the GnRH-ant group than the GnRH-a group after PSM (P<0.05). Using LB rate as the endpoint indicator, cost-effectiveness analysis showed that the cost per LB was 66 397.92 and 54 226.33 yuan in the GnRH-ant group and GnRH-a group, respectively. The incremental cost-effectiveness ratio was 15 325.88 yuan, less than 1 time of per capita GDP in China in 2018 (64 644 yuan). The results of sensitivity analysis were consistent with the results of the basic analysis. Conclusion In fresh embryo transfer cycles, the clinical outcomes and economy performances of GnRH-a protocol are superior to GnRH-ant protocol. | ||
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