Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women

Figures & data

Figure 1 Structure of the Markov model.

Note: Figure developed using TreeAge Pro 2011 software (TreeAge Software, Inc., Williamstown, MA, USA).

Table 1 Model input data: transition probabilities

Transition probabilities	Recombinant gonadotropin therapy	Urinary gonadotropin therapy
Pregnancy rates 1st cycle	0.5882	0.2222
Pregnancy rates 2nd cycle	0.5714	0.2857
Pregnancy rates 3rd cycle	0.3333	0.1818
Miscarriage rates 1st cycle	0.1	0
Miscarriage rates 2nd cycle	0	0.25
Miscarriage rates 3rd cycle	0	0

Note: Data from Carone et al.⁴

Table 2 Model input data: treatment doses and costs

Resource utilization and costs	Recombinant	Urinary
Number of vials in 1st cycle	25.767	25.529
Number of vials in 2nd cycle	25.142	24.153
Number of vials in 3rd cycle	26	25.6
Costs per vial	€119.70	€26.60

Table 3 Model input data: other health costs

Examination	Costs per unit
Examinations before the treatment
Hysterosalpingography	€116.10
Transvaginal ultrasound	€45.90
Two gynecologic visits	€21.30
Estradiol (E2)	€14.30
Follitropin (FSH)	€11.90
Seminal fluid fertility test	€7.90
Lutropin (LH)	€12.90
Prolactin (PLR)	€12.70
Thyrotropin (TSH)	€12.40
Free thyroxine (FT4)	€12.60
Free triiodothyronine (FT3)	€12.70
Blood samples drawing	€2.70
Examinations during each cycle of treatment
Four transvaginal ultrasounds	€45.90
Four gynecologic visits	€21.30
Four estradiol (E2)	€14.30
Four takings of a blood sample	€2.70
Abortion with dilation and curettage (DRG 381)	€1,300.80

Abbreviations: DRG, Diagnosis-Related Group; FSH, follicle-stimulating hormone; LH, luteinizing hormone.

Table 4 Results: costs, effectiveness, and incremental cost-effectiveness ratio (ICER) of the base case scenario

Strategy	Cost	Incremental cost	Efficacy	Incremental efficacy	ICER	Average cost per pregnancy
Urinary gonadotropin therapy	€2,719.70	–	0.50	–	–	€5,439.80
Recombinant gonadotropin therapy	€3,453.50	€733.80	0.87	0.37	€2,007.30	€3,990.00

Figure 2 Results of the probabilistic sensitivity analysis: Incremental cost-effectiveness, recombinant vs urinary gonadotropin therapy.

CaroneDCaropresoCVittiAChiappettaREfficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocolsJ Endocrinol Invest20123511996100223095369

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