ABSTRACT
The goal of the current study is to compare the cost of assisted reproductive technologies (ART) and cost-effectiveness of biotechnology products used in in vitro fertilization (IVF) procedures before and after the COVID-19 outbreak. We performed a cross sectional, observational, retrospective study of patients admitted at the biggest reference IVF clinic in Bulgaria before and after the COVID-19 outbreak with 1237 participants. Information was from patients' records;micro-costing and cost-effectiveness analysis were performed for evaluating the unit cost per successful pregnancy with different biological products. The analysis showed that the cost of therapy is lower with recombinant gonadotropins (1543.19 BGN) in the pre-COVID-19 period and with the urinary gonadotropins (1534.03 BGN) in the second period. In addition, during the second period we observed higher expenses due to additional costs for cryopreservation. During the pre-pandemic period the less effective therapy (0.14% clinical pregnancies) was the combination therapy, as well as bearing a higher cost (1749.36 BGN). The cost-effective alternative during the first, (ICER= -7000 BGN per successful pregnancy) and the second period (ICER= -2800 BGN per successful pregnancy) is the therapy with recombinant hormones. It was prescribed in 37% of the patients. After the COVID-19 outbreak the overall cost of IVF increased, even though controlled ovarian hyperstimulation cost decreased. Additional procedures are playing a role for this increase. In both periods, before and after the COVID-19 outbreak, short protocols with recombinant hormones appear to be more effective and cost-effective as an alternative.
ABSTRACT
We revisited the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS-2003) and its role in two U.S. indicators — U.S. merchandise exports to countries in the East Asia Pacific (EAP) region and domestic U.S. jobs supported by these exports. We employed a quasi-experimental approach where SARS-2003 average treatment effects were derived from comparing before-2003 and after-2003 differences in indicator trends for EAP countries that experienced the bulk of 2003 epidemic transmission (China, T aiwan, Hong Kong and Singapore) and EAP countries that did not, controlling for observed and unobserved country heterogeneity that might concurrently determine trends in trade. The SARS-2003 outbreak was associated with a USD 29 billion relative reduction in U.S. merchandise exports to the group of high-burden SARS countries, with a corresponding relative loss of 61,200 U.S. jobs. These effects were largely explained by a slowdown in exports from the U.S. manufacturing sector (USD 24.9 billion). No significant post-2003 effects were estimated for either exports or jobs, indicating a relatively quick rebound