Cost-effectiveness of recombinant and urinary follicle-stimulating hormone in assisted reproduction techniques in the private health sector in Spain

The aim of this study was to evaluate the relative cost-effectiveness of recombinant and urinary follicle-stimulating hormone (FSH) in assisted reproduction techniques in Spanish private ART clinics. Markov modelling was used to compare costs and outcomes of three complete treatment cycles using recombinant or urinary FSH for controlled ovarian stimulation. Cost and effectiveness estimates were obtained from the literature and from Spanish clinicians. A Monte Carlo technique was used to randomise the distribution of outcomes at each stage. The analysis was performed by passing a virtual population of 100 000 patients through the computer simulation in each of 5000 Monte Carlo simulations. The total number of ongoing pregnancies (±SD) generated was 42,811 ± 3,218 with r-hFSH and 39,306 ± 3,251 with u-hFSH (p < 0.0001). The cost per pregnancy achieved was ?? 19,739 ± 1,857 and ?? 20,467 ± 2,073 respectively (p < 0.0001), and the mean number of cycles per pregnancy was 4.69 and 5.21, respectively. It is concluded that recombinant FSH is more cost-effective than urinary FSH for Spanish private ART clinics.