基于倾向性评分匹配法探究拮抗剂方案与短效长方案在鲜胚移植中应用的成本-效果分析  

Cost-effectiveness Analysis of GnRH Antagonist Protocol and Short-acting GnRH Agonist Long Protocol in Fresh Embryo Transfer Based on Propensity Score Matching

作　　者：黄泰帅 池艳[1] 何萍[1] 黄国兰[1] 左延莉 HUANG Taishuai;CHI Yan;HE Ping;HUANG Guolan;ZUO Yanli(Reproductive Medicine and Genetics Center,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of General Medicine,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院生殖医学与遗传中心,广西壮族自治区南宁市530021 [2]广西医科大学全科医学院,广西壮族自治区南宁市530021

出　　处：《中国全科医学》2023年第30期3809-3814,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(71864006);广西自然科学基金资助项目(2021GXNSFAA196075,2020GXNSFAA238019);广西基层卫生健康发展研究中心(GXMUZX16);广西高等教育本科教学改革工程项目(2022JGA155);广西医药卫生自筹经费计划课题(Z20210746,Z20210984,Z20211296,GXZYZ20210115)。

摘　　要：背景辅助生殖领域越来越多地把患者的助孕成本作为制订治疗方案时的重要依据,而国内关于拮抗剂方案与短效长方案在鲜胚移植中应用的卫生经济学研究相对少见。目的基于倾向性评分匹配法(PSM)对拮抗剂方案与短效长方案在鲜胚移植中应用的临床结局行成本-效果分析。方法选择2016—2018年在广西壮族自治区人民医院生殖医学与遗传中心接受体外受精/卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗的患者1971例,共进行了2117个周期的治疗,依据控制性超促排卵(COH)方案分为拮抗剂方案组422例患者、共432个周期,短效长方案组1549例患者、共1685个周期。在电子病历系统中收集患者的基线资料〔包含女方年龄、不孕类型、不孕年限、BMI、初潮年龄、妊娠次数、基础卵泡刺激素(FSH)、基础雌二醇(E_(2))、基础黄体生成素(LH)、基础孕酮、窦卵泡数(AFC)等〕、治疗指标〔包含COH方案、使用促性腺激素(Gn)天数、Gn总量、扳机日E_(2)、扳机日LH、扳机日孕酮、扳机日子宫内膜厚度、获卵数、成熟卵母细胞数、受精方式、可移植胚胎数、优质胚胎数、移植胚胎数等〕及临床结局(包含未孕、流产、异位妊娠、活产)。应用R 4.1.1软件进行1∶1倾向性评分匹配,卡钳值设定为0.2。对匹配后的两组行成本-效果分析,应用敏感性分析验证研究结论的稳健性。结果PSM前两组女方年龄、BMI、基础FSH、基础LH、AFC比较,差异有统计学意义(P<0.05)。PSM后两组各390个周期,两组女方年龄、BMI、基础FSH、基础LH、AFC比较,差异无统计学意义(P>0.05)。治疗指标:PSM后拮抗剂方案组的Gn天数、Gn总量、扳机日E_(2)、扳机日子宫内膜厚度、获卵数、成熟卵母细胞数均小于短效长方案组,扳机日LH高于短效长方案组(P<0.05)。临床结局:PSM后拮抗剂方案组临床妊娠率(43.08%比54.62%,P=0.001)、种植率(29.15%比37.01%,P=Background In the field of assisted reproductive technology,medical cost of patients is increasingly considered as an important reference for making treatment protocols,while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist(GnRH-ant)protocol and short-acting GnRH agonist(GnRH-a)long protocol in fresh embryo transfer.Objective To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching(PSM).Methods A total of 1971 patients treated with 2117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1549 patients with 1685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation(COH).Baseline data〔including female age,type and duration of infertility,BMI,age at menarche,number of pregnancies,follicle stimulating hormone(FSH),basal estradiol(E_(2)),basal luteinizing hormone(LH),basal progesterone,antral follicle count(AFC),etc.〕,therapeutic indicators〔including COH protocols,gonadotropin(Gn)durarion,total Gn dosage,E_(2),LH,progesterone level and endometrial thickness on the trigger day,number of retrieved and mature oocytes,fertilization methods,number of transferable embryos,high-quality embryos and transferred embryos,etc.〕and the clinical outcomes〔including unpregnancy,miscarriage,ectopic gestation,live birth(LB)〕were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2.Cost-effectiveness analysis was performed on the two groups after PSM,sensitivity analysis was applied to verify the robustness of the study findings.Results There were significant differences in female age,BM

关 键 词：不育 女性 胚胎移植 排卵诱导 临床妊娠 活产率 成本-效果分析 倾向性评分匹配 

分 类 号：R271.14[医药卫生—中医妇科学]