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Ledesma B, Campbell K, Muthigi A, Ila V, Nassau DE, Ibrahim E, Ramasamy R. Semen Cryopreservation in Men with Cancer: Identifying Patterns and Challenges. JOURNAL OF FERTILITY PRESERVATION 2023; 3:246156. [PMID: 38567027 PMCID: PMC10987015 DOI: 10.32371/jfp/246156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to determine the proportion of male cancer patients who undergo semen cryopreservation before chemotherapy after referral was placed, identify factors associated with completing the procedure, and explore reasons for not moving forward with it. METHODS The electronic medical records of men with cancer who were referred to a reproductive urologist identified with an ICD-10 code for a fertility preservation procedure (Z31.62, Z31.84) between November 2021 and February 2023 were reviewed. Cancer type, semen cryopreservation rates, and reasons for opting out of the procedure were recorded. RESULTS Of the 128 men diagnosed with cancer who were referred for cryopreservation during the study period, n:67 (52%) underwent semen cryopreservation. Those who did not undergo the procedure tended to be older, with a median age of 38 years compared to those that did it (33 years) (p: 0.10). The most common reasons for non-compliance included financial burden, and lack of interest. CONCLUSION While it is recommended that patients consider fertility preservation prior to chemotherapy, our findings suggest that only half of male cancer patients completed the procedure despite referral. Further work is needed to determine barriers to access and increase awareness of fertility preservation prior to chemotherapy.
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Affiliation(s)
- Braian Ledesma
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Vishal Ila
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | - Emad Ibrahim
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
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He X, Wang X, Shen J, Wan B, Wang Y, Zhang Z, Cai L, Bao Y, Ding H, Li X. Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial. BMC Pregnancy Childbirth 2023; 23:254. [PMID: 37060068 PMCID: PMC10103395 DOI: 10.1186/s12884-023-05563-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND There are a large number of infertile couples in China, but its treatment is notoriously expensive and not currently covered by insurance. The utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization has been debated. OBJECTIVE To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. METHODS Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. MAIN OUTCOME MEASURES Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention. RESULTS The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional treatment. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24-98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. The incremental cost-effectiveness for miscarriage prevention showed that the willingness to pay would be ¥43422.60 for PGT-A to be cost-effective. CONCLUSION The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate and the high costs of PGT‑A.
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Affiliation(s)
- Xuan He
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Jiaojie Shen
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Bin Wan
- Department of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yingpeng Wang
- Department of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhuolin Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Lele Cai
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Yuwen Bao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Haixia Ding
- Department of Health Insurance Management, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
- School of Pharmacy, Nanjing Medical University, Nanjing, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Rolfes V, Bittner U, Gerhards H, Krüssel JS, Fehm T, Ranisch R, Fangerau H. Artificial Intelligence in Reproductive Medicine - An Ethical Perspective. Geburtshilfe Frauenheilkd 2023; 83:106-115. [PMID: 36643877 PMCID: PMC9833891 DOI: 10.1055/a-1866-2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/29/2022] [Indexed: 01/13/2023] Open
Abstract
Artificial intelligence is steadily being integrated into all areas of medicine. In reproductive medicine, artificial intelligence methods can be utilized to improve the selection and prediction of sperm cells, oocytes, and embryos and to generate better predictive models for in vitro fertilization. The use of artificial intelligence in this field is justified by the suffering of persons or couples who wish to have children but are unable to conceive. However, research into the use of artificial intelligence in reproductive medicine is still in the early experimental stage and furthermore raises complex normative questions. There are ethical research challenges because evidence of the efficacy of certain pertinent systems is often lacking and because of the increased difficulty of ensuring informed consent on the part of the affected persons. Other ethically relevant issues include the potential risks for offspring and the difficulty of providing sufficient information. The opportunity to fulfill the desire to have children affects the welfare of patients and their reproductive autonomy. Ultimately, ensuring more accurate predictions and allowing physicians to devote more time to their patients will have a positive effect. Nevertheless, clinicians must be able to process patient data conscientiously. When using artificial intelligence, numerous actors are involved in making the diagnosis and deciding on the appropriate therapy, raising questions about who is ultimately responsible when mistakes occur. Questions of fairness arise with regard to resource allocation and cost reimbursement. Thus, before implementing artificial intelligence in clinical practice, it is necessary to critically examine the quantity and quality of the data used and to address issues of transparency. In the medium and long term, it would be necessary to confront the undesirable impact and social dynamics that may accompany the use of artificial intelligence in reproductive medicine.
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Affiliation(s)
- Vasilija Rolfes
- 9170Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany,Korrespondenzadresse Vasilija Rolfes 9170Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät,
Heinrich-Heine-Universität DüsseldorfMoorenstraße 540225
DüsseldorfGermany
| | - Uta Bittner
- 9170Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany,84614Institut für Sozialforschung und Technikfolgenabschätzung, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Helene Gerhards
- 84614Institut für Sozialforschung und Technikfolgenabschätzung, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Jan-Steffen Krüssel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitäres interdisziplinäres Kinderwunschzentrum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf,
Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Robert Ranisch
- Juniorprofessur für Medizinische Ethik mit Schwerpunkt auf Digitalisierung, Universität Potsdam, Fakultät für Gesundheitswissenschaften Brandenburg, Potsdam, Germany,Forschungsstelle „Ethik der Genom-Editierung“, Institut für Ethik und Geschichte der Medizin, Eberhard-Karls-Universität Tübingen Medizinische Fakultät, Tübingen,
Germany
| | - Heiner Fangerau
- 9170Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Johnston M, Fuscaldo G, Gwini SM, Catt S, Richings NM. Financing future fertility: Women's views on funding egg freezing. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:32-41. [PMID: 34693043 PMCID: PMC8517713 DOI: 10.1016/j.rbms.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23-37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Giuliana Fuscaldo
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Skedgel C, Ralphs E, Finn E, Whitty JA, Markert M, Samuelsen C. Is the public supportive and willing to pay for a national assistive reproductive therapies programme? Results from a multicountry survey. BMJ Open 2021; 11:e044986. [PMID: 33692187 PMCID: PMC7949370 DOI: 10.1136/bmjopen-2020-044986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/13/2020] [Accepted: 02/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand attitudes towards infertility and willingness to pay (WTP) towards a publicly funded national assistive reproductive therapies (ART) programme. DESIGN Attitudes survey with dichotomous and open-ended WTP questions. SETTING Online survey administered in the USA, UK, Norway, Sweden, Finland, Denmark and China. PARTICIPANTS 7945 respondents, analysed by country. Nordic respondents were pooled into a regionally representative sample. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures were proportion of sample agreeing with different infertility-related and ART-related value statements and supporting a monthly contribution to fund a national ART programme, expressed in local currency. Secondary outcome measure was maximum WTP. RESULTS Across the nationally representative samples, 75.5% of all respondents agreed with infertility as a medical condition and 82.3% and 83.7% with ART eligibility for anyone who has difficulty having a baby or a medical problem preventing them from having a baby, respectively. 56.4% of respondents supported a defined monthly contribution and 73.9% supported at least some additional contribution to fund a national ART programme. Overall, converting to euros, median maximum WTP was €3.00 and mean was €15.47 (95% CI 14.23 to 16.72) per month. Maximum WTP was highest in China and the USA and lowest in the European samples. CONCLUSIONS This large, multicountry survey extends our understanding of public attitudes towards infertility and fertility treatment beyond Europe. It finds evidence that a majority of the public in all sampled countries/regions views infertility as a treatable medical condition and supports the idea that all infertile individuals should have access to treatments that improve the chance of conception. There was also strong agreement with the idea that the desire for children is a basic human need. WTP questions showed that a majority of respondents supported a monthly contribution to fund a national ART programme, although there is some evidence of an acquiescence bias that may overstate support among specific samples.
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Lima SB, Antoniassi MP, Zylbersztejn DS, Fraietta R, Bertolla RP, Ferraz MB. Willingness of Infertile Couples to Pay for In Vitro Fertilization Treatment in the Integrated Human Reproduction Section of the Escola Paulista de Medicina, São Paulo Federal University. Value Health Reg Issues 2020; 23:55-60. [PMID: 32841901 DOI: 10.1016/j.vhri.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/23/2019] [Accepted: 03/01/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the willingness to pay (WTP) of infertile couples for in vitro fertilization (IVF) treatment. METHOD This was a prospective study with an anonymous questionnaire for infertile couples in an academic setting. Clinical characteristics were analyzed by a Student's t test or Mann-Whitney test, categorical variables were compared by a chi-square or Fisher exact test, and correlations were assessed using a Spearman's test. An alpha of 5% was adopted. RESULTS Mean female and male ages were 31.5 and 35.9 years, respectively; 80.2% were married; 19.8% were in consensual union; 48.1% of women had college degrees; and 49.4% of men had a high school education. Most women (77.8%) and men (75.3%) were white, with a household income of class C. Average duration of union was 8.5 years, and average infertility was 4.7 years. Using a willingness-to-pay (WTP) evaluation and the technique of "direct questioning," the average value was determined to be R$18 720.18 (by payment scale R$22 831.17). WTP positively correlated with household income and each woman's education level. Previous parenthood or use of public health system negatively correlated with WTP. CONCLUSION We conclude that the higher the couple's monthly income and the woman's educational level, the higher the WTP for an IVF treatment; previous parenthood determined a lower WTP for an IVF treatment, and previous use of the Brazilian Unified Health System, determined a lower WTP for an IVF treatment.
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Affiliation(s)
- Samira Barbosa Lima
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Mariana Pereira Antoniassi
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil.
| | | | - Renato Fraietta
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Marcos Bosi Ferraz
- Department of Medicine, Division of Health Economics and Healthcare Management, São Paulo Federal University, São Paulo, Brazil
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Bissonnette F, Phillips S, Sampalis J, Dahdouh E, St-Michel P, Buckett W, Kadoch I, Mahutte N. Impact of government health coverage for ART: The results of a 5-year experience in Quebec. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2019; 8:32-37. [PMID: 31016250 PMCID: PMC6468154 DOI: 10.1016/j.rbms.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/19/2018] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
An analysis of national registry data for 5 years of in-vitro fertilization (IVF) funding in Quebec, Canada was compared with the previous complete year of non-funded IVF cycles, as well as the first complete year following the end of funding. The number of cycles, livebirth rates, age group of patients treated, use of donor gametes, multiple pregnancy rates and cycle cancellation rates were assessed. The total number of IVF cycles performed increased dramatically during the funded period, averaging over 10,000 cycles per year. There was no change in the age group distribution of patients treated, but less egg donation was performed. Interestingly, funding was also associated with an increase in the IVF cycle cancellation rate (17.0% versus 34.4%, P < 0.001), a dramatic decline in the multiple pregnancy rate (25.6% versus 4.9%, P < 0.001), and a decline in the livebirth rate per fresh embryo transfer in stimulated IVF cycles (32.3% versus 25.5%, P < 0.001). Although the livebirth rate for stimulated IVF declined, over 9000 babies were born as a result of the coverage. Lessons learned from this experience could help develop a more fiscally responsible programme that still facilitates access to IVF care.
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Affiliation(s)
- F. Bissonnette
- Clinique OVO, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - S. Phillips
- Clinique OVO, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | | | - E.M. Dahdouh
- University of Montreal, Montreal, Quebec, Canada
- ART Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | | | - W. Buckett
- McGill University, Montreal, Quebec, Canada
- MUHC Reproductive Centre, Montreal, Quebec, Canada
| | - I.J. Kadoch
- Clinique OVO, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - N. Mahutte
- The Montreal Fertility Centre, Montreal, Quebec, Canada
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Xue W, Lloyd A, Falla E, Roeder C, Papsch R, Bühler K. A cost-effectiveness evaluation of the originator follitropin alpha compared to the biosimilars for assisted reproduction in Germany. Int J Womens Health 2019; 11:319-331. [PMID: 31191040 PMCID: PMC6524790 DOI: 10.2147/ijwh.s193048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background and objectives: Demand for assisted reproduction technology (ART) in Germany is high, with 100,844 treatment cycles during 2016. Many ART procedures involve ovarian stimulation with follicle stimulating hormone (FSH). Recently, biosimilar FSH products have become available. The objective of this study was to evaluate the cost-effectiveness of the recombinant FSH Gonal-f® (Originator) in comparison to biosimilar follitropin alfa, Bemfola® (Biosimilar 1) and Ovaleap® (Biosimilar 2), from a German payer perspective in terms of cost per live birth. Methods: A decision tree model was developed, based on one cycle of assisted reproduction, to compare the original product to biosimilars. Clinical inputs, including live birth rates and adverse event rates were obtained from published randomized trials. Cost inputs were obtained from publicly available German sources. Clinical inputs, model structure and methodology were based on previous publications and validated by a clinical expert. Results: Results indicated that the live birth rate is higher for the Originator compared to Biosimilar 1 (40.7% vs 32.1% respectively), and Biosimilar 2 (32.2% vs 26.8%). The average cost per live birth for women treated with the Originator was estimated to be lower than those who were treated with biosimilars: Originator vs Biosimilar 1 (€10,510 vs €12,192), Originator vs Biosimilar 2 (€12,590 vs €13,606). The analysis also found that the Originator is associated with an incremental cost-effectiveness of €4,168 and €7,540 per additional live birth versus Biosimilar 1 and Biosimilar 2 respectively. Sensitivity analysis indicated probabilities of pregnancy, embryo transfer and live birth, were key drivers of model costs. Scenario analysis confirmed the robustness of the model outcomes. Conclusion: This study suggests that treatment with the Originator could result in a lower cost per live birth in comparison to biosimilars. Further analysis using real-world data, when available, is recommended to validate the results of the present study.
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Affiliation(s)
| | | | | | | | | | - Klaus Bühler
- Centre for Gynecology Endocrinology & Reproductive Medicine Kinderwunsch-Zentrum Stuttgart, Stuttgart, Germany.,Department of Gynecology, Jena-University Hospital-Friedrich Schiller University, Jena, Germany
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Pan W, Tu H, Jin L, Hu C, Li Y, Wang R, Huang W, Liao S. Decision analysis about the cost-effectiveness of different in vitro fertilization-embryo transfer protocol under considering governments, hospitals, and patient. Medicine (Baltimore) 2019; 98:e15492. [PMID: 31083186 PMCID: PMC6531099 DOI: 10.1097/md.0000000000015492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the benefits of in vitro fertilization (IVF) for patients and hospitals under different protocols and if IVF treatment should be incorporated into health care. PERSPECTIVE The government should consider including IVF treatment in health insurance. Hospitals and patients could obtain the best benefit by following the hospital's recommended protocol. SETTING This retrospective study was conducted from January 2014 to August 2017 at an academic hospital. METHODS A total of 7440 patients used gonadotropin-releasing hormone agonists (GnRHa) protocol, 2619 patients used, gonadotropin-releasing hormone antagonists (GnRHant) protocol, and 1514 patients used GnRHa ultra-long protocol. Primary outcomes were live birth rate (LBR), cost-effectiveness, hospital revenue, and government investment. RESULTS The cycle times for the GnRHa protocol and the GnRHa ultra-long protocol were significantly higher than the GnRHant protocol. Patients who were ≤29 years chose the GnRHant protocol. The cost of a successful cycle was 67,579.39 ± 9,917.55 ¥ and LBR was 29.25%. Patients who were >30 years had the GnRHa protocol as the dominant strategy, as it was more effective at lower costs and higher LBR. When patients were >30 to ≤34 years, the cost of a successful cycle was 66,556.7 ± 8,448.08 ¥ and the LBR was 31.05%. When patients were >35 years, the cost of a successful cycle was 83,297.92 ± 10,918.05 ¥ and the LBR was 25.07%. The government reimbursement for a cycle ranged between 11,372.12 ± 2,147.71 ¥ and 12,753.67 ± 1,905.02 ¥. CONCLUSIONS The government should consider including IVF treatment in health insurance. Hospitals recommend the GnRHant protocol for patients <29 years old and the GnRHa protocol for patients >30 years old, to obtain the best benefits. Patients could obtain the best benefit by using the protocol recommended by the hospital.
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Affiliation(s)
- Wei Pan
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
- School of Economic and Management, Wuhan University, Wuhan
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, China
| | - Haiting Tu
- School of Economic and Management, Wuhan University, Wuhan
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, China
| | - Lei Jin
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Cheng Hu
- School of Economic and Management, Wuhan University, Wuhan
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, China
| | - Yuehan Li
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Renjie Wang
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Weiming Huang
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - ShuJie Liao
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
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Hendriks S, Hessel M, Mochtar MH, Meissner A, van der Veen F, Repping S, Dancet EAF. Couples with non-obstructive azoospermia are interested in future treatments with artificial gametes. Hum Reprod 2016; 31:1738-48. [PMID: 27130613 DOI: 10.1093/humrep/dew095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 03/23/2016] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Would couples diagnosed with non-obstructive azoospermia (NOA) consider two future treatments with artificial gametes (AGs) as alternatives for testicular sperm extraction followed by ICSI (TESE-ICSI)? SUMMARY ANSWER Most couples with NOA (89%) would opt for treatment with AGs before attempting TESE-ICSI and/or after failed TESE-ICSI. WHAT IS KNOWN ALREADY Couples with NOA who undergo TESE-ICSI have a 25% chance of conceiving a child. Two future treatments that are being developed are 'ICSI with artificial sperm formed from somatic cells' (ICSI with AGs) and 'natural conception after autotransplantation of in vitro proliferated spermatogonial stem cells' (natural conception with AGs). It is unknown what treatment preferences patients have. STUDY DESIGN, SIZE, DURATION A cross-sectional survey conducted in 2012-2013, addressing all 921 couples diagnosed with NOA and treated with TESE-ICSI in Dutch fertility clinics between 2007 and 2012. The coded questionnaires were sent by mail and followed up with two reminders. PARTICIPANTS/MATERIALS, SETTING, METHODS We developed the questionnaire based on a literature review and previous qualitative interviews, and included treatment preference and the valuation of nine treatment characteristics. We assessed reliability of the questionnaires and calculated mean importance scores (MISs: 0-10) of each treatment characteristic. We assessed which patient and treatment characteristics were associated with a couple's hypothetical treatment preference using binominal regression. MAIN RESULTS AND THE ROLE OF CHANCE The vast majority (89%) of the 494 responding couples (response rate: 54%) would potentially opt for AGs as a first and/or a last resort treatment option. More specifically, as a first treatment couples were likely (67%) to prefer natural conception with AGs over TESE-ICSI and less likely to prefer ICSI with AGs over TESE-ICSI (34%). After failed TESE-ICSI, the majority of couples (75%) would want to attempt ICSI with AGs as a last resort option. The most important characteristics of treatment were safety for children (MIS: 8.2), pregnancy rates (MIS: 7.7) and curing infertility (MIS: 6.8). Costs, burden, naturalness and technological sophistication were of about equal importance (MIS: 3.1-4.0). The majority of patients rated conception at home and moral acceptability as not important (MIS: 1.7 and 0.8, respectively), but the importance attributed to these variables did still affect patients' likeliness to opt for AGs. LIMITATIONS AND REASONS FOR CAUTION Couples with NOA not opting for TESE-ICSI were not included and might have other perspectives. Couples' hypothetical choices for AGs might differ from their actual choices once data on the costs, safety and pregnancy rates become available from these new treatment options. WIDER IMPLICATIONS OF THE FINDINGS The interest of couples with NOA in potential future treatments with AGs encourages further pre-clinical research. Priority setting for research and future decision-making on clinical application of AGs should take all characteristics important to patients into account. STUDY FUNDING/COMPETING INTERESTS The authors report no financial or other conflict of interest relevant to the subject of this article.
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Affiliation(s)
- S Hendriks
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Hessel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M H Mochtar
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A Meissner
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E A F Dancet
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands KU Leuven, Department of Development and Regeneration, Leuven University Fertility Clinic, Leuven, Belgium
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11
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Abstract
Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced.
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Affiliation(s)
- Pek Joo Teoh
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
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12
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Hodgetts K, Hiller JE, Street JM, Carter D, Braunack-Mayer AJ, Watt AM, Moss JR, Elshaug AG. Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups. BMC Health Serv Res 2014; 14:204. [PMID: 24885716 PMCID: PMC4016640 DOI: 10.1186/1472-6963-14-204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Methods Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Results Each forum demonstrated stakeholders’ capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around ‘equity’ and ‘patient responsibility’, culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Conclusions Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical, accountable policy decisions in the specific area of ART and health care more broadly. Notably, reductionist, deterministic characterizations of stakeholder ‘self-interest’ proved unfounded as each group sought to prioritise universal values (in particular, ‘equity’ and ‘responsibility’) over specific, within-group concerns. Our results - from an emotive case study in ART - highlight that evidence-informed disinvestment decision-making is feasible, and potentially less controversial than often presumed.
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Affiliation(s)
| | | | | | | | | | | | | | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Coppleson Building D02, Sydney, NSW 2006, Australia.
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13
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An international survey of assisted reproductive technologies (ARTs) policies and the effects of these policies on costs, utilization, and health outcomes. Health Policy 2014; 116:238-63. [PMID: 24698476 DOI: 10.1016/j.healthpol.2014.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/07/2014] [Accepted: 03/07/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to compare existing policies regarding access to 7 assisted reproductive technologies (ARTs) and to examine the effects of these policies on costs, utilization, and health outcomes in 14 countries and 2 Canadian provinces based on publicly available information. METHODS A systematic review of publicly available information from peer-reviewed literature (using biomedical and social science databases) and grey literature (e.g., health ministry websites, health technology assessment agency websites, etc.) was performed. RESULTS ARTs services permitted or funded vary across jurisdictions. The goals and eligibility restrictions (e.g., on maternal age, number of embryos transferred, and number of cycles) defined in ARTs policies also vary across jurisdictions. Studies on the impact of such policies have primarily been retrospective and focused on short-term service utilization. Nevertheless, they suggest that the policies have achieved specific outcomes, such as reductions in multiple births and in costs to payers. CONCLUSIONS Based on the evidence reviewed, policies aimed at reducing public coverage of ARTs or restricting the number of embryos transferred have achieved these goals. However, their effects on maternal and infant health outcomes have not been well explored.
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14
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Milardi D, Grande G, Sacchini D, Astorri AL, Pompa G, Giampietro A, De Marinis L, Pontecorvi A, Spagnolo AG, Marana R. Male fertility and reduction in semen parameters: a single tertiary-care center experience. Int J Endocrinol 2012; 2012:649149. [PMID: 22319527 PMCID: PMC3272805 DOI: 10.1155/2012/649149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022] Open
Abstract
Background. Infertility is both a clinical and a public problem, affecting the life of the couple, the healthcare services, and social environment. Standard semen analysis is the surrogate measure of male fertility in clinical practice. Objective. To provide information about the relationship between semen parameters and spontaneous conception. Methods. We evaluated retrospectively 453 pregnancies that occurred among 2935 infertile couples evaluated at an infertility clinic of a tertiary-care university hospital, between 2004 and 2009. Results. Normal semen analysis was present only in 158 patients; 295 subfertile patients showed alterations in at least one seminal parameter. A reduction in all seminal parameters was observed in 41 patients. Etiological causes of male infertility were identified in 314 patients. Conclusion. Our data highlights the possibility of a spontaneous conception with semen parameters below WHO reference values. Therefore, we support the importance of defining reference values on a population of fertile men. Finally, we analyzed the related ethical issues.
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Affiliation(s)
- D. Milardi
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
- *D. Milardi:
| | - G. Grande
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - D. Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. L. Astorri
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - G. Pompa
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Giampietro
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - L. De Marinis
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Pontecorvi
- Unit of Endocrinology, Department of Clinical Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - R. Marana
- Department of Obstetrics and Gynecology, International Scientific Institute “Paolo VI”, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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15
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Aleyamma TK, Kamath MS, Muthukumar K, Mangalaraj AM, George K. Affordable ART: a different perspective. Hum Reprod 2011; 26:3312-8. [PMID: 21987524 DOI: 10.1093/humrep/der323] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although ≈ 10% of the population is affected by infertility, the treatment option of in-vitro fertilisation (IVF) remains unaffordable for the majority of infertile couples. We have initiated a lowcost programme incorporating an uncommonly used, but recognized, ovarian stimulation protocol, together with certain costlimiting initiatives in an established assisted reproductive technology (ART) set up. METHODS The medical records of women who underwent the lowcost programme were analysed. Clomiphene citrate 50 mg daily was administered from Day 2 of the cycle and continued till the day of hCG trigger, thus preventing the LH surge. Intermittent doses of human menopausal gonadotrophin 150 IU were administered on alternate days from the 5th day onwards. Oocyte retrieval was carried out once at least two follicles of >18 mm were identified. The cycle was monitored by ultrasound only, with embryo transfer being carried out on Day 3. Clinical outcomes were recorded together with an estimation of the direct costs per cycle. Direct cost calculations did not include professional charges or facility costs. RESULTS Of 143 women evaluated, 104 women underwent embryo transfer. The live birth rate and clinical pregnancy rate per embryo transfer were 19 and 22%. The live birth rate per initiated cycle was 14% (20/143). The multiple pregnancy rate was 26% with no case of ovarian hyperstimulation syndrome being recorded. The average direct cost per cycle was US$ 675 for IVF and US$ 725 for an ICSI treatment cycle. CONCLUSIONS Using this protocol, together with several costcutting measures, we achieved an acceptable live birth rate per transfer of 19% at a reasonable cost. This approach could be used by established ART centres to provide treatment to couples who cannot afford conventional ART.
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Affiliation(s)
- T K Aleyamma
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu 632004, India
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16
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Rauprich O, Berns E, Vollmann J. Information provision and decision-making in assisted reproduction treatment: results from a survey in Germany. Hum Reprod 2011; 26:2382-91. [PMID: 21742732 DOI: 10.1093/humrep/der207] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate the views of patients and experts in Germany on information provision and decision-making in assisted reproduction treatment (ART). METHODS Standard questionnaire techniques were used for interviewing Reproductive Physicians (n= 230), Psychosocial Counsellors (n = 66) and Patients (n = 1590). Descriptive data analyses and non-parametric tests for significance were performed. RESULTS Higher scores were assigned for information on the chances for treatment success and on direct, physical risks of fertility treatment than for information on the risks and burden of multiple pregnancies and on the emotional risks and burden associated with infertility treatment. Three-quarters (74%) of the Patients (P) reported that they had experienced an overwhelming desire for a child at some point during their treatment, and half (47%) stated that they had experienced the feeling of losing control over the situation. According to 25% of the Reproductive Physicians (RP) and 47% of the Psychosocial Counsellors (PC), patients are often or very often limited in their capacity to decide when to stop the treatment. CONCLUSIONS A significant number of patients in reproductive care in Germany are not well informed on all the aspects that are relevant for treatment decision-making, are overwhelmed by their desire for a child, lose control over the situation, and are limited in their capacity to end unsuccessful treatment. Information provision should be ensured and monitored during treatment by standardized safeguards. A strategy for stopping ART and embarking on alternative ways of coping with infertility should be installed from the outset of every treatment.
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Affiliation(s)
- O Rauprich
- Institute for Medical Ethics and History of Medicine, Ruhr-Universität Bochum, Bochum, Germany.
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Rauprich O, Berns E, Vollmann J. Die Finanzierung der Reproduktionsmedizin. GYNAKOLOGISCHE ENDOKRINOLOGIE 2011. [DOI: 10.1007/s10304-010-0405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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