The cost-effectiveness of IVF in the UK: a comparison of three gonadotrophin treatments

BACKGROUND: The objective of this study was to evaluate the cost-effectiveness of women undergoing IVF treatment with recombinant FSH (rFSH) in comparison with highly purified urinary FSH (uFSH-HP) and human menopausal gonadotrophins (HMG). METHODS: A decision-analytic model was used to estimate cost-effectiveness ratios for `the average cost per ongoing pregnancy' and `incremental cost per additional pregnancy' for women entering into IVF treatment for a maximum of three cycles. The model was constructed based on a previously published large prospective randomized clinical trial comparing rFSH and uFSH-HP. Where necessary, these data were augmented with a combination of expert opinion, evidence from the literature and observational data relating to the management and cost of IVF treatment in the UK. The cost of rFSH, uFSH-HP and HMG were obtained from National Health Service list prices in the UK. RESULTS: The model predicted a cumulative pregnancy rate after three cycles of 57.1% for rFSH and 44.4% for both uFSH-HP and HMG. The cost of IVF treatment was pound 5135 for rFSH, pound 4806 for uFSH-HP and pound 4202 for HMG. When assessed in association with outcomes, the average cost per ongoing pregnancy was more favourable with rFSH (pound 8992) than with either uFSH-HP (pound 10 834) or HMG (pound 9472). The incremental cost per additional pregnancy was pound 2583 using rFSH instead of uFSH-HP and pound 7321 using rFSH instead of HMG. These results were robust to changes in the baseline assumptions of the model. CONCLUSION: rFSH is a cost-effective treatment strategy in ovulation induction prior to IVF.