Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation.

Full Abstract

BACKGROUND:
To compare the clinical results and the cost-effectiveness of using the aromatase inhibitor, letrozole, in conjunction with FSH and FSH alone for controlled ovarian stimulation (COS) in patients undergoing intrauterine insemination (IUI) for a variety of indications.

METHODS:
Four hundred and thirty-two consecutive patients who underwent 872 IUI cycles were included. The study population was composed of two groups. Group I included 308 patients who underwent 589 IUI cycles with letrozole and FSH for the following indications:
anovulation (143 cycles), male factor infertility (147 cycles), unexplained infertility (250 cycles), endometriosis (18 cycles) and combined indications (31 cycles). Group II included 124 patients who underwent 283 IUI cycles who received FSH only for the following indications:
ovarian factor infertility (82 cycles), male factor infertility (66 cycles), unexplained infertility (114 cycles), endometriosis (13 cycles) and other indications (8 cycles). Main outcome measures included number of mature follicles >16 mm in diameter, dose of FSH used per cycle, clinical pregnancy rate and cost-effectiveness ratio per pregnancy.

RESULTS:
FSH dose required for ovarian stimulation was significantly lower when letrozole was used (P < 0.0001). Although a significantly higher number of follicles >16 mm and endometrial thickness at the day of hCG administration (P < 0.0001) were observed in Group II, pregnancy rate per started (14.4 versus 15.9%) and per completed cycles (15.77 versus 18.07%) was the same in Group I and Group II, respectively. IUI cancellation rate was significantly lower with letrozole treatment (P = 0.05%). The cost per cycle was significantly lower in Group I versus Group II (468.93 Can dollars +/- 418.18 versus 1067.28 +/- 921.43; P < 0.0001). The cost-effectiveness ratio was 3249.42 dollars in the letrozole group and 6712.00 dollars in the FSH-only group.

CONCLUSION:
A letrozole-FSH combination could be an effective ovarian stimulation protocol in IUI cycles. Such a protocol may be more cost-effective than FSH alone because of the difference of FSH dose and cost. A randomized controlled trial is needed to further substantiate this finding.

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Author information

Author/s: Bedaiwy, Mohamed A (MA); Forman, Rachel (R); Mousa, Noha A (NA); Al Inany, Hesham G (HG); Casper, Robert F (RF);

Affiliation: Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.

Journal and publication information

Publication Type: Controlled Clinical Trial; Journal Article

Journal: Human reproduction (Oxford, England) (Hum Reprod), published in England. (Language: eng)

Reference: 2006-Nov; vol 21 (issue 11) : pp 2838-44

Dates: Created 2006/10/12; Completed 2007/01/29;

PMID: 16877370, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aromatase Inhibitors - economics; therapeutic use
Cost-Benefit Analysis
Costs and Cost Analysis
Endometrium - drug effects; pathology
Female
Follicle Stimulating Hormone - therapeutic use
Humans
Infertility, Male

Male
Menstrual Cycle
Nitriles - economics; therapeutic use
Ontario
Ovulation Induction - methods
Pregnancy
Pregnancy Outcome
Triazoles - economics; therapeutic use

Associated Chemicals: Aromatase Inhibitors (0) ; Nitriles (0) ; Triazoles (0) ; letrozole (112809-51-5) ; Follicle Stimulating Hormone (9002-68-0)

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