Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

dc.contributor.authorMaldonado, Luiz Guilherme Louzada [UNESP]
dc.contributor.authorFranco Junior, Jose Gonçalves [UNESP]
dc.contributor.authorSetti, Amanda Souza
dc.contributor.authorIaconelli Jr., Assumpto
dc.contributor.authorBorges Jr., Edson
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionRibeirão Preto
dc.contributor.institutionSapientiae Institute-Educational and Research Center in Assisted Reproduction
dc.contributor.institutionFertility-Assisted Fertilization Center
dc.date.accessioned2014-05-27T11:29:01Z
dc.date.available2014-05-27T11:29:01Z
dc.date.issued2013-05-01
dc.description.abstractObjective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine.en
dc.description.affiliationDepartment of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, Av. Brigadeiro Luiz Antonio, 4545-Jardim Paulista, São Paulo/SP
dc.description.affiliationProf. Franco Jr. Center for Human Reproduction Ribeirão Preto, São Paulo
dc.description.affiliationSapientiae Institute-Educational and Research Center in Assisted Reproduction, São Paulo
dc.description.affiliationFertility-Assisted Fertilization Center, São Paulo
dc.description.affiliationUnespDepartment of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, Av. Brigadeiro Luiz Antonio, 4545-Jardim Paulista, São Paulo/SP
dc.format.extent1615-1622
dc.identifierhttp://dx.doi.org/10.1016/j.fertnstert.2013.01.095
dc.identifier.citationFertility and Sterility, v. 99, n. 6, p. 1615-1622, 2013.
dc.identifier.doi10.1016/j.fertnstert.2013.01.095
dc.identifier.issn0015-0282
dc.identifier.issn1556-5653
dc.identifier.scopus2-s2.0-84876970476
dc.identifier.urihttp://hdl.handle.net/11449/75210
dc.identifier.wosWOS:000318612400026
dc.language.isoeng
dc.relation.ispartofFertility and Sterility
dc.relation.ispartofjcr4.803
dc.relation.ispartofsjr2,250
dc.rights.accessRightsAcesso restrito
dc.sourceScopus
dc.subjectControlled ovarian stimulation
dc.subjectGnRHa
dc.subjectGnRHant ICSI
dc.subjectpituitary down-regulation
dc.subjectcetrorelix
dc.subjectrecombinant chorionic gonadotropin
dc.subjectrecombinant follitropin
dc.subjecttriptorelin
dc.subjectadult
dc.subjectcontrolled study
dc.subjectcost effectiveness analysis
dc.subjectdown regulation
dc.subjectdrug dose reduction
dc.subjectembryo transfer
dc.subjectfemale
dc.subjectfertilization in vitro
dc.subjecthuman
dc.subjecthuman cell
dc.subjectintracytoplasmic sperm injection
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectoocyte
dc.subjectoutcome assessment
dc.subjectpregnancy rate
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectrandomized controlled trial
dc.subjectspontaneous abortion
dc.subjectAdult
dc.subjectCost-Benefit Analysis
dc.subjectDown-Regulation
dc.subjectDrug Administration Schedule
dc.subjectEmbryo Transfer
dc.subjectFemale
dc.subjectFertilization in Vitro
dc.subjectFollicle Stimulating Hormone
dc.subjectFollow-Up Studies
dc.subjectGonadotropin-Releasing Hormone
dc.subjectHumans
dc.subjectPituitary Gland
dc.subjectPregnancy
dc.subjectProspective Studies
dc.subjectRecombinant Proteins
dc.subjectTreatment Outcome
dc.subjectTriptorelin Pamoate
dc.titleCost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatmentsen
dc.typeArtigo
dcterms.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt
unesp.departmentGinecologia e Obstetrícia - FMBpt

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