Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Abstract

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.

Figure 1

Patient preference to reduce number of daily injections vs. IVF patient age. Preference distribution regarding decreasing the number of daily injections and importance of reducing out-of-pocket (non-reimbursed) cost as a function of IVF patient age, where patients recorded their priority for A (prefer to reduce total number of daily injections), B (prefer to reduce out-of-pocket cost), C (no preference if there were no difference in cost), or D (prefer GnRH-antagonist, but this would be influenced by cost).

Figure 2

Cost comparisons between GnRH-antagonist vs. GnRH-agonist. Cost-to-patient (in 2012 U.S. dollars) for GnRH-antagonist (back) [B] and GnRH-agonist (front) [A] as measured in 11 retail pharmacies. Entries 1–3 were obtained from IVF specialty pharmacies, while data from sites 4–11 were derived from community pharmacies.