Fecundação In Vitro em Portugal: um Estudo de Custo-Efectividade

• Main Authors: Vladimiro Silva, Pedro Pita Barros, Óscar Lourenço, Francisco Batel Marques
• Format: Article
• Language: English
• Published: Formifarma, LDA. 2011-07-01
• Series: Revista Portuguesa de Farmacoterapia
• Subjects: Cost-effectiveness; assisted reproductive technologies; in vitro fertilisation; gonadotropins
• Online Access: http://revista.farmacoterapia.pt/index.php/rpf/issue/view/23/showToc

Objectives: To perform an economic evaluation comparing urinary and recombinant gonadotropins in ovarian stimulation for in vitro fertilisation (IVF) in the National Health Service perspective. Pituitary suppression was achieved through the use of gonadotropin-releasing hormone (GnRH) agonists in a long protocol. Incremental cost-effectiveness ratios of one alternative versus the other were calculated for three different age groups. Effectiveness was measured in deliveries. Methods: Effectiveness data came from the combination of results provided by two large, international, multicentric randomized controlled trials and the Portuguese Assisted Reproductive Technologies (ART) National Registry. Medication costs and reimbursement rates were obtained from official sources. Medication usage levels were the most efficient to achieve reported consumption levels. Considered ART treatment costs were obtained from government published prices. Results: Urinary gonadotropins are the dominant treatment strategy, with higher effectiveness and lower costs. Cost differences ranged from 95,83€ to 159,90€ in the analysed age groups. Incremental cost-effectiveness ratios obtained were -2886,21€ (≤34 years old), -3386,89€ (35-39 years old) and -21575,52€ (≥40 years old) per delivery. Sensitivity analysis showed that the main results did not change substantially after key parameters in the model were varied. Conclusions: Urinary gonadotropins are the most cost-effective alternative in IVF treatments after long protocol with GnRH agonist. The cost-savings achieved using urinary gonadotropins would allow for the delivery of an additional IVF cycle for every 20 cycles.