非PCOS卵巢高反应患者鲜胚移植或冻融胚胎移植成本效益分析  

Cost-effectiveness analysis of frozen-thawed embryos or fresh embryo transfer of IVF in non-PCOS patients with hyper ovarian response

作　　者：李艳辉 方雨晴 张寒珂 刘琳[1] 高颖 LI Yan-hui;FANG Yu-qing;ZHANG Han-ke;LIU Lin;GAO Ying(Department of Gynecology&Obstetrics,Union Hospital,Huazhong University of Science&Technology,Wuhan430022)

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,武汉430022

出　　处：《生殖医学杂志》2021年第5期575-581,共7页Journal of Reproductive Medicine

基　　金：国家自然科学基金项目(81701423);武汉中青年医学骨干人才培养工程项目。

摘　　要：目的探讨非多囊卵巢综合征(PCOS)卵巢高反应患者行鲜胚移植或冻融胚胎移植(FET)的成本效益。方法选择2015年1月1日至2019年6月30日在华中科技大学同济医学院附属协和医院生殖中心接受IVF/ICSI-ET治疗的非PCOS卵巢高反应患者1622例,根据移植方式不同分为鲜胚移植组(514例)和FET组(1108例),比较两组患者卵巢刺激结果和妊娠结局,计算两组患者第1次移植过程中产生的直接和间接成本,并采用决策树模型进行成本效益分析。结果两组患者的平均年龄、不孕年限、体重指数(BMI)、基础窦卵泡计数(AFC)、抗苗勒管激素(AMH)水平、基础FSH/LH值、原发/继发不孕比例及不孕原因分布均无显著性差异(P>0.05)。两组患者卵巢刺激结果显示,FET组的平均Gn天数、平均Gn用量及获卵数均显著多于鲜胚移植组(P<0.05),但两组患者的平均可利用胚胎数并无显著性差异(P>0.05)。第1次移植后的临床妊娠率、持续妊娠率比较,FET组显著高于鲜胚移植组(P<0.05),但两组患者的累积持续妊娠率并无显著性差异(P>0.05)。成本效益分析显示,为获1例持续妊娠,鲜胚移植组的费用为64841.12元,FET组费用为64752.14元;对比鲜胚移植组,FET组为多获1例持续妊娠的增量成本效益比(ICER)为63990.47元。结论非PCOS卵巢高反应患者行鲜胚移植或FET的累积持续妊娠率和成本效益比基本相当,因此此类患者移植方式的选择仍应强调个体化。Objective:To investigate the cost-effectiveness of fresh embryo transfer or frozen-thawed embryos transfer(FET) of IVF in non-polycystic ovary syndrome(non-PCOS) women with hyper ovarian response.Methods:A total of 1 622 non-PCOS patients with hyper ovarian response who received IVF/ICSI-ET treatment in our reproductive center from January 1,2015 to June 30,2019 were selected. According to different transplantation methods, the patients were divided into the fresh embryo transfer group(n=514) and the FET group(n=1 108). The ovarian stimulation status and pregnancy outcomes were compared between the two groups. The direct and indirect costs during the first cycle of embryo transfer were calculated, and the decision tree model was used for cost-effectiveness analysis.Results:There were no significant differences in mean age, duration of infertility, body mass index(BMI),basal antral follicle count(AFC),anti-Mullerian hormone(AMH) level, basal FSH/LH value, primary/secondary infertility ratio and distribution of infertility causes between the two groups(P>0.05). The results of ovarian stimulation showed that the average number of Gn days, the average dosage of Gn and the number of oocytes retrieved in the FET group were significantly higher than those in the fresh embryo transfer group(P<0.05),but there was no significant difference in the average number of embryos available between the two groups(P>0.05). The clinical pregnancy rate and ongoing pregnancy rate after the first transplantation in FET group were significantly higher than those in fresh embryo transfer group(P<0.05),but there was no significant difference in the cumulative ongoing pregnancy rate between the two groups(P>0.05). The cost-effectiveness analysis showed that the mean costs per ongoing pregnancy was ￥64 841.12 in fresh embryo transfer group, and ￥64 752.14 in the FET group. The incremental cost-effectiveness ratio(ICER) of the FET group compared with the fresh embryo transfer group was ￥63 990.47 for one more ongoing pregnancy.Conclusio

关 键 词：卵巢高反应 鲜胚移植 冻融胚胎移植 持续妊娠率 成本效益分析 

分 类 号：R711.6[医药卫生—妇产科学]