3种促排卵药物在IVF-ET/ICSI中的临床疗效与经济学分析——1项基于真实世界的回顾性分析

Clinical Efficacy and Economic Analysis of Three Ovulation Induction Drugs in IVF-ET/ICSI——A Retrospective Analysis Based on Real World

关键词:  促排卵  体外受精-胚胎移植/卵胞浆内单精子注射  最小成本分析法

Key words:  ovulation  in vitro fertilization-embryo transfer/intracytoplasmic sperm injection  cost-minimization analysis

摘要:

目的 基于最小成本分析和决策树模型，比较3个促排卵药物在体外受精-胚胎移植/卵胞浆内单精子注射（in vitro fertilization-embryo transfer/intracytoplasmic sperm injection，IVF-ET/ICSI）中的临床疗效与经济学分析。方法 回顾性分析2017年3月—2018年12月在上海交通大学医学院附属国际和平妇幼保健院辅助生殖中心采用拮抗剂方案控制性超促排卵进行IVF-ET/ICSI的患者，共282个周期，按照患者使用促性腺激素（gonadotropin，Gn）药物的不同分为A组：重组人促卵泡激素a注射液108个周期；B组：注射用尿源性促卵泡素87个周期；C组：重组人促卵泡激素β注射液87个周期。比较3组的一般情况、成本及治疗结局，采用最小成本分析法对3组促排卵药物的治疗方案进行药物经济学评价。结果 3组的一般情况及治疗结局差异无统计学意义，3组的直接医疗总成本差异有统计学意义（P<0.05），A、B、C组的直接医疗成本分别为15 737.58元、14 782.68元、13 421.20元。3组均无明显不良反应发生。C组成本最小，B组次之，A组最大。故C组治疗方案最具经济性。结论 在IVF-ET/ICSI的3组促排卵药物治疗方案中，重组促卵泡素β注射液更具经济学优势，注射用尿促卵泡素次之，重组人促卵泡激素注射液不具优势。

Abstract:

OBJECTIVE To compare the clinical efficacy of three ovulation-induction drugs on treatment outcomes in in vitro fertilization-embryo transfer/intracytoplasmic sperm injection(IVF-ET/ICSI) and economic analysis based on cost-minimization analysis and decision-making tree. METHODS A total of 282 cycles of IVF-ET/ICSI who received their treatment with controlled ovarian stimulation with antagonist regimen in the reproductive center of The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine from March 2017 to December 2018 were retrospectively selected according to the different gonadotropin(Gn) drugs used by patients, and divided into group A:recombinant human follicle stimulating hormone α injection for 108 cycles; group B:urinary follicle stimulating hormone injection for 87 cycles; group C:recombinant human follicle stimulating hormone β injection for 87 cycles. The the general conditions, treatment costs, clinical efficacy of the three groups were observed, cost-minimization analysis were adopted to conduct pharmacoeconomic evaluation on the three therapeutic regimens. RESULTS There was no significant difference in general characteristics and treatment outcomes. The difference in total direct medical cost among the three groups was statistically significant(P<0.05). The total direct medical cost of group A, group B and group C were respectively 15 737.58 yuan, 14 782.68 yuan and 13 421.20 yuan. No obvious adverse drug reactions were found in three groups. The cost of group C was the smallest, the second was group B and the largest was group A. Therefore, treatment in group C is the most economical. CONCLUSION In the three regimens in treatment of IVF-ET/ICSI, recombinant follicle stimulating hormone β injection has more advantage in economic, followed by urinary follicle stimulating hormone for injection, while the recombinant follicle stimulating hormone injection has no advantage.