Abstract:
Background In the field of assisted reproductive technology, treatment cost of patients is increasingly seen as an important reference for making treatment plans, while domestic health economics research on the cost-effectiveness of gonadotropin-releasing hormone (GnRH) antagonist protocol and GnRH agonist short-acting protocol in fresh embryo transfer is relatively rare. Objective To explore the cost-effectiveness of GnRH antagonist protocol and GnRH agonist short-acting protocol in fresh embryo transfer by propensity score matching (PSM). Methods A retrospective analysis involving 432 GnRH antagonist protocol cycles and 1685 GnRH agonist short-acting protocol cycles in the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 was performed. A new sample of 390 pairs was obtained by PSM. Pregnancy outcomes and cost-effectiveness of the two groups after matching were analyzed. The research conclusion was verified by sensitivity analysis. Results After matching there were significant differences (P < 0.01) in clinical pregnancy rate (43.08% vs. 54.62%), implantation rate (29.15% vs. 37.01% ), live birth rate (33.59% vs. 44.10%), the average cost of medication per cycle (6533.50 � 2536.50 yuan vs. 7870.97�2566.74 yuan) and the total cost per cycle (23733.81 � 5647.82 yuan vs. 25313.54 � 5492.36 yuan) between GnRH antagonist protocol group and GnRH agonist short-acting protocol group. The cost per live birth in GnRH antagonist protocol group was 70657.37 yuan, which was higher than 57400.32 yuan in GnRH agonist short-acting protocol group. The incremental cost-effectiveness ratio is 15030.73 yuan, less than 1 time of China's per capita GDP in 2018 (64644 yuan). The results of sensitivity analysis and cost-effectiveness analysis were in consistency. Conclusion In fresh embryo transfer cycles, GnRH agonist short-acting protocol results in a better clinical outcome and cost-effectiveness than GnRH antagonist protocol.
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