Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-05-05 Cooperative journals: 《中国全科医学》
Abstract： Background In the field of assisted reproductive technology，medical cost of patients is increasingly considered as an important reference for making treatment protocols，while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist （GnRH-ant） protocol and short-acting GnRH agonist（GnRH-a）long protocol in fresh embryo transfer. Objective To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching （PSM）. Methods A total of 1 971 patients treated with 2 117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET） at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1 549 patients with 1 685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation （COH）.Baseline data 〔including female age，type and duration of infertility，body mass index（BMI），age at menarche，number of pregnancies，follicle stimulating hormone（FSH），basal estradiol（E2），basal luteinizing hormone （LH），basal progesterone，antral follicle count（AFC），etc.〕，therapeutic indicators 〔including COH protocols，gonadotropin（Gn） durarion，total Gn dosage，E2，LH，progesterone level and endometrial thickness on the trigger day，number of retrieved and mature oocytes，fertilization methods，number of transferable embryos，high-quality embryos and transferred embryos，etc.〕 and the clinical outcomes〔including unpregnancy，miscarriage，ectopic gestation，live birth（LB）〕 were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2. Cost-effectiveness analysis was performed on the two groups after PSM，sensitivity analysis was applied to verify the robustness of the study findings. Results There were significant differences in female age，BMI，basal FSH，LH，and AFC between the two groups before PSM（P<0.05）. 390 cycles were included in each group after PSM，and there was no significant difference in female age，BMI，basal FSH，LH，and AFC between the two groups after PSM（P>0.05）. Therapeutic indicators including Gn duration，Gn dosage，E2 and endometrial thickness on the trigger day，number of retrieved and mature oocytes were lower in the GnRH-ant group than GnRH-a group，while LH level on the trigger day was higher in the GnRH-ant than the GnRH-a group（P<0.05） after PSM. Clinical outcomes including clinical pregnancy rate（43.08% vs. 54.62%，P=0.001），implantation rate（29.15% vs. 37.01%，P=0.001），and LB rate（33.59% vs. 44.10%，P=0.003） were significantly lower in the GnRH-ant group than GnRH-a group after PSM. The median cost of ovulation induction drug per cycle and median total cost per cycle were lower in the GnRH-ant group than the GnRH-a group after PSM（P<0.05）. Using LB rate as the endpoint indicator，cost-effectiveness analysis showed that the cost per LB was 66 397.92 and 54 226.33 yuan in the GnRH-ant group and GnRH-a group，respectively. The incremental cost-effectiveness ratio was 15 325.88 yuan，less than 1 time of per capita GDP in China in 2018（64 644 yuan）. The results of sensitivity analysis were consistent with the results of the basic analysis. Conclusion In fresh embryo transfer cycles，the clinical outcomes and economy performances of GnRH-a protocol are superior to GnRH-ant protocol.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-01-09 Cooperative journals: 《中国全科医学》
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.
Subjects: Medicine, Pharmacy >> Other Disciplines of Medicine and Pharmacology submitted time 2024-04-19 Cooperative journals: 《中国全科医学》
Abstract： Background In order to change the shortage of general practitioners in primary care，China has been implementing a rural order-oriented medical student training program in 2010. Currently，the overall performance intention， performance situation and retention intention of order-oriented medical students in China still remains unclear and need to be supported by more reliable evidence. Objective To systematically evaluate the performance intention rate，actual performance rate and retention intention rate of order-oriented medical students in China and analyze its influencing factors. Methods From January to June 2022，CNKI，Wanfang Data，VIP，PubMed and Embase databases were searched to collect literature related to service intention，performance intention and retention intention for primary care of order-oriented medical students in China with a time period from 2010-01-01 to 2021-12-01，and the language of the literature was limited to Chinese and English. Two investigators independently screened literature and extracted data independently to evaluate the risk of bias of the included studies. Meta-analysis of single-group rates was performed using RevMan 5.4 software. Results A total of 49 papers were included with a survey period of 2010-2020，involving 22 413 order-oriented medical students. The performance intention rate of order-oriented medical students was 62%［95%CI（55%-69%）］，the performance rate was 95%［95%CI（93%-96%）］，the retention intention rate was 16%［95%CI（13%-19%）］. The results of subgroup analysis showed that the performance intention rate of the literature published in 2011［90%，95%CI（84%-96%）］ was higher than the other years（P<0.01），the performance intention rate was higher in North China［87%，95%CI（84%-90%）］ than the other regions，the performance intention rate of college students［68%，95%CI（67%-69%）］ was higher than the residents in standardization training（P<0.01）；the performance rate of the published literature in 2020 ［99%，95%CI（99%-100%）］ was higher than the other years（P<0.01）， and the performance rate［100%，95%CI（99%-100%）］ in Central China was higher than the other regions（P<0.01）； the retention intention rate of the literature published in 2015［36%，95%CI（2%-70%）］ was higher than the other years（P<0.01）， the retention intention rate［23%，95%CI（4%-41%）］ was higher in South China than the other regions（P<0.01），the retention intention rate of the college students［18%，95%CI（13%-22%）］ was higher than the residents in standardization training and primary care providers performing contracts（P<0.01）. Conclusion The actual performance rate of order-oriented medical students in China is high，but the performance intention rate and retention intention rate are low. Region，time and medical education stage are the influencing factors.
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