Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients
Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients
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DOI：
10.1186/1477-7827-10-67
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发表时间：
2012-08-30
影响因子：
4.4
通讯作者：
Salem, Rifaat D.
中科院分区：
文献类型：
--
作者：
Sills, E. Scott;Collins, Gary S.;Salem, Rifaat D.
背景：在体外受精（IVF）过程中，生育患者预计将自我管理许多注射作为这种治疗的一部分。虽然已经开发了新的药物来大幅减少这些注射的次数，但这些药物通常要昂贵得多。考虑到这些差异的成本和注射次数，本研究比较了GnRH激动剂和GnRH拮抗剂为基础的协议在IVF.Methods的患者的喜好：通过自愿，匿名问卷调查，在第一次咨询预约收集数据。患者对s.c.总数的意见。结果：完成的问卷调查（n = 71）显示平均+/- SD患者年龄为34 +/- 4.1岁。（83.1%）没有既往IVF经验; 2.8%报告了需要自我皮下给药的其他疾病。当[A]和[B]的自付费用相同时，50.7%的患者偏好[B]。在健康职业的患者中，倾向于方案[B]的倾向较弱。[A]和[B]的估计患者成本分别为259.82 +/- 11.75美元和654.55 +/- 106.34美元（p < 0.005）。测量患者偏好[B]减少的成本differentiations.Conclusions：这项调查发现一致较高的非报销的直接药物费用GnRH拮抗剂IVF与GnRH激动剂IVF协议。在一些（但不是所有）IVF患者亚组中观察到条件性偏好，以尽量减少下调（使用GnRH拮抗剂）。与健康职业的IVF患者相比，对GnRH拮抗剂的偏好弱于其他患者。虽然通过使用GnRH拮抗剂减少注射总次数是一个理想的目标，但似乎所有IVF患者都没有平等地感受到这一优势，并且当非报销药物费用达到临界水平时，患者可能会严重折扣其效用。
Background: During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF.Methods: Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied.Results: Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased.Conclusions: This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.