Recombinant Human Follicle-Stimulating Hormone in Controlled Ovarian Hyperstimulation with Assisted Reproductive Technology in China: A Cost-Effectiveness Analysis

Figures & data

Figure 1 Cost-effectiveness model decision-tree structure of rhFSH for ART.

Table 1 Transition Probabilities for Key States in the Model

	GONAL-f
	n	Total number of patients^#	Transition probability	Lower limit	Upper limit	Distribution
Oocyte retrieval	132	133	99.2%	97%	100%	Beta
Embryo transfer-fresh cycle	132	132	100%	100%	100%	Beta
Clinical pregnancy-fresh cycle	61	132	46.21%	38%	55%	Beta
Live birth-fresh cycle*	56	61	91.8%	84%	97%	Beta
Embryo transfer-frozen cycle**	76	76	100%	90%	100%	Beta
OHSS-mild to moderate	3	133	2.26%	0	5%	Beta
OHSS-severe	1	133	0.75%	0	3%	Beta
	JinSaiHeng
	n	Total number of patients^#	Transition probability	Lower limit	Upper limit	Distribution
Oocyte retrieval	127	134	94.8%	90%	98%	Beta
Embryo transfer-fresh cycle	127	127	100%	100%	100%	Beta
Clinical pregnancy-fresh cycle	54	127	42.52%	34%	51%	Beta
Live birth-fresh cycle*	54	54	100%	100%	100%	Beta
Embryo transfer-frozen cycle**	73	73	100%	90%	100%	Beta
OHSS- mild to moderate	6	134	4.48%	0	5%	Beta
OHSS- severe	1	134	0.75%	0	3%	Beta

Notes: *Live birth rate in the model was defined as the proportion of patients with successful pregnancies; ^#Total number of patients with successful pregnancies. **It was assumed that 100% of women who do not achieve a successful delivery of a live neonate, would have a successful embryo transfer with a frozen embryo.

Abbreviations: rhFSH, Recombinant human follicle stimulating hormone; OHSS, Ovarian hyper-stimulation syndrome.

Table 2 Daily Dosing of GONAL-f and JinSaiHeng

	Total dose (IU)	Mean Daily dose (IU)	Treatment Duration (day)
Originator rhFSH-α	2215.4	199.6	11.1
Biosimilar rhFSH	2302.2	203.7	11.3

Abbreviation: rhFSH, Recombinant human follicle stimulating hormone.

Table 3 ART, Birth, OHSS Related Cost Inputs

	Model Inputs value	Lower Limit	Upper Limit	Distribution
ICSI & IVF (%)
IVF follicle punctuations	73	70	78	Dirichlet
ICSI follicle punctuations	27	22	31	Dirichlet
IVF/ICS related cost (CNY)
General treatment, treatment plan	82	20	145	Gamma
Serological tests	3192	2000	4500	Gamma
Oocyte retrieval	2540	1500	4500	Gamma
Discontinuation before ovum pick-up	2075	1600	2500	Gamma
Anesthesia, including monitoring	783	250	1200	Gamma
IVF and embryo transfer	7133	1500	13,400	Gamma
ICSI and embryo transfer	10,200	6500	15,400	Gamma
IVF, no embryo transfer	5900	3000	11,000	Gamma
ICSI, no embryo transfer	8580	5000	13,000	Gamma
Blood test for β-HCG, pregnancy test	44	30	50	Gamma
Birth-related cost (CNY)
Live birth	10,021	7000	12,750	Gamma
Miscarriage	1548	500	2690	Gamma
OHSS costs (CNY)
Blood test (×1)	19	18	20	Gamma
Liver function test (×1)	220	189	250	Gamma
Hospitalization	8750	75,000	27,500	Gamma
B-mode ultrasonography	125	70	180	Gamma

Abbreviations: IVF, In vitro fertilization; ICSI, Intracytoplasmic sperm injection; OHSS, Ovarian hyper-stimulation syndrome.

Table 4 Incremental Cost-Effectiveness Analysis of GONAL-f and JinSaiHeng

	GONAL-f	JinSaiHeng	Difference
Clinical outcome
Cumulative live birth rate (%)	88.3	84.4%	3.9%
Cost outcome
Medication cost (CNY)	6945	6998	−53
OHSS management costs (CNY)	75	85	−11
IVF/ICSI costs (CNY)	23,207	22,415	792
Birth-related costs (CNY)	15,247	14,485	762
Total costs (CNY)	45,474	43,983	1,490
Cost-effectiveness outcome
Cost per cumulative live birth* (CNY)	51,475	52,095	−620
Incremental cost per additional live birth (CNY)	38,096

Notes: *Cost per cumulative live birth=total cost/cumulative live birth rate; ICER= total cost difference/cumulative live birth rate difference.

Abbreviations: OHSS, Ovarian hyper-stimulation syndrome; rhFSH, Recombinant human follicle stimulating hormone; IVF, In vitro fertilization; ICSI, Intracytoplasmic sperm injection.

Figure 2 Tornado graph of OWSA. OWSA for cost input was estimated using a 25% variation of parameters, while OWSA for clinical efficacy by 10% variance.

Figure 3 Cost-effectiveness acceptability curve based on probabilistic sensitivity analysis.