The Economic Study Of GnRH-agonist Long-protocol And GnRH-antagonist Protocol For IVF-ET

ObjectiveTo compare the cost and effect of the gonadotropin-releasing hormone agonist(GnRH-a)long protocol and GnRH antagonist protocol for in vitro fertilization-embryo transfer(IVF-ET),a more economical and effective ovarian stimulation protocol was selected.MethodsA retrospective analysis was performed on 2,259 patients who used GnRH-a long-protocol and GnRH-antagonist protocol to induce ovulation in our hospital from January 2015 to December 2017 for the first time.The results of the two protocols were compared and calculated respectively.Then a decision tree model was built to simulate the fresh embryo and frozen embryo transplantation process.Economics was carried out by using minimum cost analysis and cost effect analysis.ResultsThe number of oocytes retrieved and available embryos in the GnRH-a long-protocol was higher than that in the GnRH-antagonist protocol(13.90±6.58 vs 11.89±6.70,P<0.01;4.42±3.43 vs 3.98±3.27,P=0.005).In the fresh embryo transplantation cycle,there was no significant difference in the clinical pregnancy rate and ongoing pregnancy rate between the GnRH-a long-protocol and GnRH-antagonist protocol(47.26% VS49.44%;P=0.487;38.77% VS 37.22%,P=0.613).When all available embryos had been utilized,the rate of cumulative ongoing pregnancy per start cycle was 60.65% for GnRH-antagonist protocol and 71.6% for GnRH-agonist long-protocol(P<0.01).In the fresh embryo transplantation cycle,the average cost of the GnRH-agonist long-protocol was ? 130160.66,and the average cost of the GnRH-antagonist protocol was?110989.38.When the cumulative ongoing pregnancy rate was taken into account,the mean costs per ongoing pregnancy were estimated at ?49673.16 and at ?53476.01 with the GnRH-agonist long-protocol and the GnRH-antagonist protocol,respectively.The ICER for GnRH-agonist long-protocol versus GnRH-antagonist protocol was estimated at ?28618.73 for one more ongoing pregnancy.ConclusionIf only fresh embryo transplantation was considered,the GnRH-antagonist protocol was less costly than the GnRH-agonist long-protocol.However,when cumulative ongoing pregnancy rates were taken into account,more economic advantages were found in the GnRH-agonist long-protocol than the GnRH-antagonist protocol.