Research question

How do costs and effects of in-vitro maturation (IVM) compare to IVF in women with a high antral follicle count (AFC)?

Design

This cost-effectiveness analysis (CEA) was based on data of a previous retrospective cohort study at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Between July 2015 and December 2017, 608 women underwent IVM and 311 women IVF. The effectiveness measure for the CEA was cumulative live birth rate (LBR) after one completed cycle including subsequent cryo-cycles within 12 months of inclusion. Data were collected on resource use related to treatment, medication and pregnancy from the case report forms. The mean costs and effects, average cost differences and incremental cost-effectiveness ratios (ICER) were calculated using non-parametric bootstrap resampling to assess the effect of uncertainty in the estimates.

Results

Cumulative LBR after one completed cycle were 239/608 (39.3%) in the IVM group versus 155/311 (49.8%) in the IVF group (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.30–0.89). Ovarian hyperstimulation syndrome (OHSS) did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. The mean costs per couple were €4300 (95% CI €1371–18,798) for IVM and €6493 (95% CI €2204–20,136) for IVF. The ICER per additional live birth with IVF was €20,144 (95% CI €9116–50,418). Results were robust over a wide range of assumptions.

Conclusions

IVM is less expensive than IVF in women with a high AFC undergoing treatment with assisted reproductive technology, while leading to a slightly lower effectiveness in terms of cumulative LBR.

中文翻译：

---

体外成熟与试管婴儿：成本效益分析

研究问题

在窦卵泡计数 (AFC) 较高的女性中，体外成熟 (IVM) 的成本和效果与 IVF 相比如何？

设计

该成本效益分析 (CEA) 基于之前在越南胡志明市 My Duc 医院 IVFMD 进行的一项回顾性队列研究的数据。2015 年 7 月至 2017 年 12 月期间，608 名女性接受了 IVM，311 名女性接受了 IVF。CEA 的有效性衡量指标是一个完整周期后的累积活产率 (LBR)，包括纳入后 12 个月内的后续冷冻周期。从病例报告表中收集了与治疗、药物治疗和怀孕相关的资源使用数据。平均成本和影响、平均成本差异和增量成本效益比 (ICER) 是使用非参数引导重采样来计算的，以评估估计中不确定性的影响。

结果

一个完整周期后的累积 LBR 在 IVM 组中为 239/608 (39.3%)，而在 IVF 组中为 155/311 (49.8%)（调整后的优势比为 0.52，95% 置信区间 [CI] 0.30-0.89）。IVM 组未发生卵巢过度刺激综合征 (OHSS)，而 IVF 组的发生率为 11/311 (3.5%)。每对夫妇的平均成本为 IVM 4300 欧元（95% CI 1371-18,798 欧元），IVF 6493 欧元（95% CI 2204-20,136 欧元）。体外受精每额外活产的 ICER 为 20,144 欧元（95% CI 9116–50,418 欧元）。结果在广泛的假设范围内都是稳健的。

结论

对于接受辅助生殖技术治疗的 AFC 高的女性，IVM 比 IVF 便宜，同时导致累积 LBR 的有效性略低。