Economic evaluation of highly purified human menotropin or recombinant follicle-stimulating hormone for controlled ovarian stimulation in high-responder patients: analysis of the Menopur in Gonadotropin-releasing Hormone Antagonist Single Embryo Transfer-High Responder (MEGASET-HR) trial.
Objective
To determine the cost of achieving a live birth after first transfer using highly purified human menotropin (HP-hMG) or recombinant follicle-stimulating hormone (FSH) for controlled ovarian stimulation in predicted high-responder patients in the Menopur in Gonadotropin-releasing hormone Antagonist Single Embryo Transfer-High Responder (MEGASET-HR) trial.


Design
Cost minimization analysis of trial results.


Setting
Thirty-one fertility centers.


Patients
Six hundred and nineteen women with serum antimüllerian hormone ≥5 ng/mL.


Interventions
Controlled ovarian stimulation with HP-hMG or recombinant FSH in a gonadotropin-releasing hormone (GnRH) antagonist assisted reproduction cycle where fresh transfer of a single blastocyst was performed unless ovarian response was excessive whereupon all embryos were cryopreserved and patients could undergo subsequent frozen blastocyst transfer within 6 months of randomization.


Main Outcome Measures
Mean cost of achieving live birth after first transfer (fresh or frozen).


Results
First-transfer efficacy, defined as live birth after first fresh or frozen transfer, was 54.5% for HP-hMG and 48.0% for recombinant FSH (difference 6.5%). Average cost to achieve a live birth after first transfer (fresh or frozen) was lower with HP-hMG compared with recombinant FSH. For fresh transfers, the cost was lower with HP-hMG compared with recombinant FSH. The average cost to achieve a live birth after first frozen transfer was also lower in patients treated with HP-hMG compared with recombinant FSH.


Conclusions
Treatment of predicted high-responders with HP-hMG was associated with lower cost to achieve a live birth after first transfer compared with recombinant FSH.


Clinical Trial Registration Number
NCT02554279.
['Robins|Jared C|JC|', 'Khair|Andrew F|AF|', 'Widra|Eric A|EA|', 'Alper|Michael M|MM|', 'Nelson|Winnie W|WW|', 'Foster|Eric D|ED|', 'Sinha|Anshul|A|', 'Ando|Masakazu|M|', 'Heiser|Patrick W|PW|', 'Daftary|Gaurang S|GS|']
Menopur recombinant FSH GnRH antagonist high responders highly purified menotropin