Abstract
Original language | English |
---|---|
Pages (from-to) | 99-104 |
Number of pages | 6 |
Journal | Reproductive BioMedicine Online |
Volume | 40 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jan 2020 |
Keywords
- Clomiphene citrate
- Cost-effectiveness
- Gonadotrophins
- Intrauterine insemination
- Subfertility
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In: Reproductive BioMedicine Online, Vol. 40, No. 1, 01.2020, p. 99-104.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis
AU - Amsterdam SUPER Study Group
AU - Danhof, Noor A.
AU - van Wely, Madelon
AU - Repping, Sjoerd
AU - van der Ham, David P.
AU - Klijn, Nicole
AU - Janssen, Ineke C. A. H.
AU - Rijn-van Weert, Janne-Meije
AU - Twisk, Moniek
AU - Traas, Maaike A. F.
AU - Pelinck, Marie-Louise J.
AU - Perquin, Denise A. M.
AU - Boks, Dominique E. S.
AU - Sluijmer, Alexander
AU - Mol, Ben W. J.
AU - van der Veen, Fulco
AU - Mochtar, Monique H.
N1 - Funding Information: We thank all couples that participated in the SUPER study, the hospitals and their staff, the research nurses and the staff of the Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology for logistic support and the staff of the Clinical Research Unit of the Academic Medical Centre, Amsterdam, for their help with the randomization programme and the online database. The initial RCT received funding from the Dutch Organisation for Health Research and Development (ZonMw) (Health Care Efficiency Research; project number 80-83600-98-10192). In addition to the authors, the SUPER Study Group included: Carolien Koks, Department of Obstetrics and Gynaecology, M?xima Medical Centre, Veldhoven; J Gianotten, Department of Obstetrics and Gynaecology, Kennemer Hospital, Haarlem; Jan Peter de Bruin, Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, Den Bosch; BJ Cohlen, Department of Obstetrics and Gynecology, Isala Hospital, Zwolle; MHA van Hooff, Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam; FJM Broekmans, Centre for Reproductive Medicine, University Medical Centre Utrecht, Utrecht; K Fleischer, Centre for Reproductive Medicine, Radboud University Medical Centre, Nijmegen; J van Disseldorp, Department of Obstetrics and Gynaecology, St. Antonius Hospital Nieuwegein, Nieuwegein; MFG Verberg, Fertility Clinic Twente; J Visser, Department of Obstetrics and Gynaecology Amphia, Breda; HR Verhoeve, Department of Obstetrics and Gynaecology, OLVG Amsterdam-Oost; CF van Heteren, Department of Obstetrics and Gynaecology, Canisius Wilhelmina Hospital, Nijmegen; A Sluijmer, Department of Obstetrics and Gynaecology, Wilhelmina Hospital, Assen. Funding Information: We thank all couples that participated in the SUPER study, the hospitals and their staff, the research nurses and the staff of the Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology for logistic support and the staff of the Clinical Research Unit of the Academic Medical Centre, Amsterdam, for their help with the randomization programme and the online database. The initial RCT received funding from the Dutch Organisation for Health Research and Development ( ZonMw ) (Health Care Efficiency Research; project number 80-83600-98-10192). In addition to the authors, the SUPER Study Group included: Carolien Koks, Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven; J Gianotten, Department of Obstetrics and Gynaecology, Kennemer Hospital, Haarlem; Jan Peter de Bruin, Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, Den Bosch; BJ Cohlen, Department of Obstetrics and Gynecology, Isala Hospital, Zwolle; MHA van Hooff, Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam; FJM Broekmans, Centre for Reproductive Medicine, University Medical Centre Utrecht, Utrecht; K Fleischer, Centre for Reproductive Medicine, Radboud University Medical Centre, Nijmegen; J van Disseldorp, Department of Obstetrics and Gynaecology, St. Antonius Hospital Nieuwegein, Nieuwegein; MFG Verberg, Fertility Clinic Twente; J Visser, Department of Obstetrics and Gynaecology Amphia, Breda; HR Verhoeve, Department of Obstetrics and Gynaecology, OLVG Amsterdam-Oost; CF van Heteren, Department of Obstetrics and Gynaecology, Canisius Wilhelmina Hospital, Nijmegen; A Sluijmer, Department of Obstetrics and Gynaecology, Wilhelmina Hospital, Assen. Noor Danhof is a PhD candidate at the Centre for Reproductive Medicine of the Amsterdam University Medical Centre, Amsterdam, the Netherlands. Key message Unlabelled box Because healthcare costs have been rising over the years, it is essential to be aware of the costs in clinical decision-making. Gonadotrophins are more expensive than clomiphene citrate in couples with unexplained subfertility undergoing intrauterine insemination with adherence to strict cancellation criteria, without being significantly more effective. Publisher Copyright: © 2019 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1
Y1 - 2020/1
N2 - 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.
AB - 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.
KW - Clomiphene citrate
KW - Cost-effectiveness
KW - Gonadotrophins
KW - Intrauterine insemination
KW - Subfertility
UR - http://www.scopus.com/inward/record.url?scp=85076512718&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.rbmo.2019.09.004
DO - https://doi.org/10.1016/j.rbmo.2019.09.004
M3 - Article
C2 - 31787550
SN - 1472-6483
VL - 40
SP - 99
EP - 104
JO - Reproductive BioMedicine Online
JF - Reproductive BioMedicine Online
IS - 1
ER -