P-452 Economic impact of antagonist stimulation protocol vs progestin primed stimulation protocol in oocyte donor program A retrospective study
Authors: Gonzalo Carballes J 
Published: June 2023

Abstract

Study question
Is the cost per oocyte lower in antagonist ovarian stimulation protocol vs progestin primed ovarian stimulation protocol in oocyte donation program?

Summary answer
The cost per oocyte is lower in progestin primed stimulation protocol in oocyte donation program

What is known already
1. The use of progesterone during ovarian stimulation is effective in blocking the LH surge, and it does not affect the number of oocytes collected or the quality of the embryos obtained. Progestins can be used orally and are less expensive than GnRH analogues. These new regimens enable more flexibility and are interesting but their medical and economic significance remains to be demonstrated.

Study design, size, duration
Calculation of cost-effectiveness ratios (cost per mature oocyte achieved) using data derived from retrospective clinical practice in a large egg donor program of a single University Hospital between 2011 and 2021 5677 egg donor cycles identified from the electronic medical records database were eligible.

Participants/materials, setting, methods
Donors fulfilled national legal and medical-guide requirements, 18- 35 y.o, regular menstrual cycles, BMI 18-30 Kg/m2, no relevant medical history and normal karyotype. They were divided into 2 groups(4subgroups): Antagonist FSH stimulation group(subcategory recombinant and biosimilar FSH) and Progestin primed FSHstimulation group(subcategory recombinant and biosimilar FSH). Demographic data were collected and compared between groups. The cost per unit of gonadotrophin, progestin and antagonist was calculated according to the manufacturer’s sale price.

Main results and the role of chance
The mean age of women recruited into the study was 26,5 years. The distribution into the different study groups was as follows:
1.1. 3155 (55,6%) in recombinant FSH antagonists group (FSHrA), Mean days stimulation 9,17-antagonists 4,91; mature eggs:13,62
2.2. 1489 (26,2%) in biosimilar recombinant FSH antagonist group (FSHrbA), Mean days: stimulation 9,17-antagonists 5,28; mean mature eggs: 13,37
3.3. 187 (3%) in recombinant FSH progestin primed group (FSHrPP), Mean days stimulation 9,26-desogestrel 23; mean mature eggs: 12,54
4.4. 846 (14,9%) in biosimilar recombinant FSH progestin primed group(FSHrbPP). Mean days stimulation 9,07-desogestrel 24; Mean mature eggs: 13,78
According to clinical outcomes in oocyte donor, we did not find statistical differences neither in the mean of days of stimulation nor in mature eggs collected in each treatment group but there is a higher rate in the range of 0-4 mature eggs collected in Progestin primed group.
The costs for each drug were as follows: 0,33-0,382€ per unit of recombinant FSH; 0,299-0,33€ per unit of recombinant biosimilar FSH; 25,85€ per unit of Ganirelix; 0,14 per unit of Desogestrel.
In conclusion, cost savings can be achieved using FSH progestin primed treatment. The cost per mature oocyte is 52,59€ compared with 58,25€ per oocyte in FSH antagonist group.

Limitations, reasons for caution
Cancellations before reaching pickup are not contemplated,they may increase the total cost of the cycle.
Although the days of stimulation are equivalent in the different groups, the cost of visits including the costs of nursing, infrastructure, patient care time and consumables might be different between the groups.

Wider implications of the findings
Progestins can present an effective option for egg donation programs in terms of cost

Trial registration number
not applicable