Cost-effectiveness of in vitro fertilization and controlled ovarian hyperstimulation before and after the COVID-19 outbreak

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.