Kosteneffektivität von rekombinantem FSH (r-hFSH) bei assistierten reproduktionstechniken (ART) in Deutschland: Modellierung im Vergleich zu urinärem FSH (u-hFSH)

Purpose: The objective of the study was to compare the efficacy and cost-effectiveness of recombinant follicle stimulating hormone (r-hFSH) with urinary FSH (u-hFSH) for attaining clinical pregnancy in assisted reproduction techniques in Germany. Methods: A realistic comparison of ART treatments must consider several cycles. To overcome the limitations of clinical studies for assessments of complex long-term treatments and to integrate various data sources a Markovian decision framework model and a Monte-Carlo simulation were used. The complete model of 4 cycles of ART involving fresh cycles and frozen embryo transfer comprised 579 health states. Information on costs and probabilities were provided by national formulary costs and clinic tariffs, meta-analyses of randomised controlled clinical trials, medical literature and the national IVF-registry. A panel of experts validated all the data. This approach provided distributions of transition probabilities for all health states and allowed to calculate precise standard deviations for each outcome. Results: The study involved 5000 Monte-Carlo simulations of treatment on a Markov cohort of 100,000 patients per treatment group. The total number of ongoing pregnancies attained was significantly higher in the r-hFSH (49,171) compared with the u-hFSH (46,186) group. The cost per successful pregnancy was significantly lower for r-hFSH (EUR 21, 686, 45) compared with u-hFSH( EUR 22, 188.53). To achieve an ongoing pregnancy fewer cycles of treatment were required.