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Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation.
Hum Reprod. 2006 Nov; 21(11):2838-44.HR

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.

Authors+Show Affiliations

Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

16877370

Citation

Bedaiwy, Mohamed A., et al. "Cost-effectiveness of Aromatase Inhibitor Co-treatment for Controlled Ovarian Stimulation." Human Reproduction (Oxford, England), vol. 21, no. 11, 2006, pp. 2838-44.
Bedaiwy MA, Forman R, Mousa NA, et al. Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation. Hum Reprod. 2006;21(11):2838-44.
Bedaiwy, M. A., Forman, R., Mousa, N. A., Al Inany, H. G., & Casper, R. F. (2006). Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation. Human Reproduction (Oxford, England), 21(11), 2838-44.
Bedaiwy MA, et al. Cost-effectiveness of Aromatase Inhibitor Co-treatment for Controlled Ovarian Stimulation. Hum Reprod. 2006;21(11):2838-44. PubMed PMID: 16877370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation. AU - Bedaiwy,Mohamed A, AU - Forman,Rachel, AU - Mousa,Noha A, AU - Al Inany,Hesham G, AU - Casper,Robert F, Y1 - 2006/07/27/ PY - 2006/8/1/pubmed PY - 2007/1/30/medline PY - 2006/8/1/entrez SP - 2838 EP - 44 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 21 IS - 11 N2 - 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. SN - 0268-1161 UR - https://www.unboundmedicine.com/medline/citation/16877370/Cost_effectiveness_of_aromatase_inhibitor_co_treatment_for_controlled_ovarian_stimulation_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/del273 DB - PRIME DP - Unbound Medicine ER -