BACKGROUND: Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF. METHODS: Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. The main outcome measures are total costs of treatment within a 12 months period after randomization, and the relationship between total costs and proportion of cumulative pregnancies resulting in term live birth within 1 year of randomization. RESULTS: Despite a significantly increased average number of IVF cycles (2.3 versus 1.7; P < 0.001), lower average total costs over a 12-month period (8333 versus €10 745; P = 0.006) were observed using the mild strategy. This was mainly due to higher costs of the obstetric and post-natal period for the standard strategy, related to multiple pregnancies. The costs per pregnancy leading to term live birth were €19 156 in the mild strategy and €24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was €185 000 per extra pregnancy leading to term live birth. CONCLUSIONS: Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.

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Human Reproduction
Erasmus MC: University Medical Center Rotterdam

Polinder, S, Heijnen, E.M, Macklon, N.S, Habbema, J.D.F, Fauser, B.C.J.M, & Eijkemans, M.J.C. (2008). Cost-effectiveness of a mild compared with a standard strategy for IVF: A randomized comparison using cumulative term live birth as the primary endpoint. Human Reproduction, 23(2), 316–323. doi:10.1093/humrep/dem372