Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis

Amsterdam SUPER Study Group

doi:10.1016/j.rbmo.2019.09.004

Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis

Amsterdam SUPER Study Group

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	99-104
Number of pages	6
Journal	Reproductive Biomedicine Online
Volume	40
Issue number	1
Early online date	16 Sept 2019
DOIs	https://doi.org/10.1016/j.rbmo.2019.09.004
Publication status	Published - Jan 2020

Funding

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.

Keywords

Clomiphene citrate
Cost-effectiveness
Gonadotrophins
Intrauterine insemination
Subfertility

Access to Document

10.1016/j.rbmo.2019.09.004Licence: Unspecified

Cite this

@article{bdab7d7372214a5aa57035b7ed9c5ca4,

title = "Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis",

abstract = "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.",

keywords = "Clomiphene citrate, Cost-effectiveness, Gonadotrophins, Intrauterine insemination, Subfertility",

author = "Danhof, \{Noor A.\} and \{van Wely\}, Madelon and Sjoerd Repping and \{van der Ham\}, \{David P.\} and Nicole Klijn and Janssen, \{Ineke C.A.H.\} and \{Rijn-van Weert\}, \{Janne Meije\} and Moniek Twisk and Traas, \{Maaike A.F.\} and Pelinck, \{Marie Louise J.\} and Perquin, \{Denise A.M.\} and Boks, \{Dominique E.S.\} and Alexander Sluijmer and Mol, \{Ben W.J.\} and \{van der Veen\}, Fulco and Mochtar, \{Monique H.\} and \{Amsterdam SUPER Study Group\}",

year = "2020",

month = jan,

doi = "10.1016/j.rbmo.2019.09.004",

language = "English",

volume = "40",

pages = "99--104",

journal = "Reproductive Biomedicine Online",

issn = "1472-6483",

publisher = "Elsevier Limited",

number = "1",

}

TY - JOUR

T1 - Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination

T2 - a cost-effectiveness analysis

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.

AU - Amsterdam SUPER Study Group

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 - 10.1016/j.rbmo.2019.09.004

DO - 10.1016/j.rbmo.2019.09.004

M3 - Article

C2 - 31787550

AN - SCOPUS:85076512718

SN - 1472-6483

VL - 40

SP - 99

EP - 104

JO - Reproductive Biomedicine Online

JF - Reproductive Biomedicine Online

IS - 1

ER -

Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Cite this