Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Danhof, Noor A.; van Wely, Madelon; Repping, Sjoerd; van der Ham, David P.; Klijn, Nicole; Janssen, Ineke C.A.H.; Rijn-van Weert, Janne-Meije; Twisk, Moniek; Traas, Maaike A.F.; Pelinck, Marie-Louise J.; Perquin, Denise A.M.; Boks, Dominique E.S.; Sluijmer, Alexander; Mol, Ben W.J.; van der Veen, Fulco; Mochtar, Monique H.
• Is Part Of: Reproductive biomedicine online. Volume 40:Issue 1(2020)
• Page Start: 99
• Page End: 104
• Publication Date: 2020-01
• Subjects: Clomiphene citrate -- Cost-effectiveness -- Gonadotrophins -- Intrauterine insemination -- Subfertility; Human reproductive technology -- Periodicals; Human embryo -- Periodicals; Reproduction -- Periodicals; 616.692
• DOI: 10.1016/j.rbmo.2019.09.004
• Languages: English
• ISSNs: 1472-6483

Abstract

Abstract: Research question: What is the cost-effectiveness of gonadotrophins compared with clomiphene citrate in couples with unexplained subfertility undergoing intrauterine insemination (IUI) with ovarian stimulation under strict cancellation criteria? Design: A cost-effectiveness analysis alongside a randomized controlled trial (RCT). Between July 2013 and March 2016, 738 couples were randomized to gonadotrophins (369) or clomiphene citrate (369) in a multicentre RCT in the Netherlands. The direct medical costs of both strategies were compared. Direct medical costs included costs of medication, cycle monitoring, insemination and, if applicable, pregnancy monitoring. Non-parametric bootstrap resampling was used to investigate the effect of uncertainty in estimates. The cost-effectiveness analysis was performed according to intention-to-treat. The incremental cost-effectiveness ratio (ICER) between gonadotrophins and clomiphene citrate for ongoing pregnancy and live birth was assessed. Results: The mean costs per couple were €1534 for gonadotrophins and €1067 for clomiphene citrate (mean difference of €468; 95% confidence interval [CI] €464–472). As ongoing pregnancy rates were 31% in women allocated to gonadotrophins and 26% in women allocated to clomiphene citrate (relative risk 1.16, 95% CI 0.93–1.47), the ICER was €21, 804 (95% CI €11, 628–31, 980) per additional ongoing pregnancy with gonadotrophins and €17, 044 (95% CI €8998–25, 090) per additional live birth with gonadotrophins. Conclusions: Gonadotrophins are more expensive compared with clomiphene citrate in couples with unexplained subfertility undergoing IUI with adherence to strict cancellation criteria, without being significantly more effective.