Open AccessCost‐effectiveness study of clomiphene citrate versus anastrozole for inducing ovulation in infertile adult patients in a public hospital, La Raza in Mexico City
Author(s) -
Martínez Núñez Juan Manuel,
Altagracia Martínez Marina,
Ríos Camilo,
Kravzov Jinich Jaime,
Hinojosa Cruz Juan Carlos,
Vital Reyes Victor Saúl
Publication year - 2011
Publication title -
journal of pharmaceutical health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.244
H-Index - 15
eISSN - 1759-8893
pISSN - 1759-8885
DOI - 10.1111/j.1759-8893.2010.00027.x
Subject(s) - medicine , anastrozole , cost effectiveness , gynecology , ovulation induction , cost effectiveness analysis , quality adjusted life year , obstetrics , tamoxifen , ovulation , cancer , breast cancer , risk analysis (engineering) , hormone
Objective To evaluate the cost‐effectiveness (CE) ratio of clomiphene citrate versus anastrozole in the induction of ovulation in infertile adult women attending a Mexican public hospital. Methods A CE study was conducted from a hospital perspective. A clinical pilot study was carried out at the La Raza hospital. Thirty patients with infertility due to anovulation were recruited and grouped as follows: group A was treated with clomiphene citrate and group B with anastrozole. Efficacy data and adverse events of both drugs were obtained from the above‐described clinical pilot study with Mexican women patients and through a systematic review of published medical literature. Efficacy data were analysed using meta‐analysis; direct and indirect costs were gathered and calculated by the micro‐costing technique, and a 1‐year time horizon was considered. The Monte Carlo Markov model was used, and quality‐adjusted life years (QALYs) were used as the unit of effectiveness. Incremental and sensitivity analyses were performed and we investigated the effect of a 5% discount rate. Key findings The odds ratios from the meta‐analysis were 0.86 for ovulation induction and 1.46 for pregnancy. The most cost‐effective therapy was clomiphene citrate at US$405/QALY in comparison to US$457/QALY for anastrozole. The incremental cost was US$52/QALY. The result of the discount rate for the most cost‐effective therapy projected for 5 years was US$1288. The sensitivity analysis did not show changes for the most cost‐effective therapy when the effectiveness probabilities or the treatment costs were modified. Conclusion Conventional treatment with clomiphene citrate therapy has the highest cost‐effectiveness for the population studied.