Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomised comparison using cumulative term live birth as the primary endpoint

Polinder, S., Heijnen, E.M.E.W., Macklon, N.S., Habbema, J.D.F., Fauser, B.J.C.M. and Eijkemans, M.J.C. (2008) Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomised comparison using cumulative term live birth as the primary endpoint. Human Reproduction, 23 (2), 316-323. (doi:10.1093/humrep/dem372).

Abstract

Background: conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF.

Methods: four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. The main outcome measures are total costs of treatment within a 12 months period after randomization, and the relationship between total costs and proportion of cumulative pregnancies resulting in term live birth within 1 year of randomization.

Results: despite a significantly increased average number of IVF cycles (2.3 versus 1.7; P < 0.001), lower average total costs over a 12-month period (8333 versus {euro}10 745; P = 0.006) were observed using the mild strategy. This was mainly due to higher costs of the obstetric and post-natal period for the standard strategy, related to multiple pregnancies. The costs per pregnancy leading to term live birth were {euro}19 156 in the mild strategy and {euro}24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was {euro}185 000 per extra pregnancy leading to term live birth.

Conclusions: despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.

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