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. 2023 Jul;12(7):e230003.
doi: 10.57264/cer-2023-0003. Epub 2023 Jun 22.

Screening for diminished ovarian reserve in Portugal: a cost-saving answer to shorten the fertility journey

Pedro Xavier  1 , Sofia Dantas  2 , Teresa Almeida-Santos  3 , Sérgio Reis Soares  4 , Ryan J Imhoff  5 , Victória Genovez  6 , Cátia Modesto  7 , Helena Gens  8 , Inês Correia  9 , Carlos Catalão  10
Affiliations

Screening for diminished ovarian reserve in Portugal: a cost-saving answer to shorten the fertility journey

Pedro Xavier et al. J Comp Eff Res. 2023 Jul.

Abstract

Aim: Assess the budget impact of nationwide screening for diminished ovarian reserve (OR), via anti-Müllerian hormone (AMH) levels, to the Portugal National Health System (NHS). Patients & methods: The clinical journey was determined using literature and the family planning decision-making process/response using survey results. A panel of four local clinicians validated all assumptions/inputs. Results: Screening for OR led to an expected savings of € 9.4 million for the NHS, driven by a 24% reduction in medically assisted reproduction (MAR) use. When needed, referral for MAR was earlier and more women used first-line versus second-line techniques. The model estimated a 12% decrease in failure. Conclusion: This model shows AMH screening may allow more informed decisions, leading to a shorter fertility journey, more efficient use of treatments, and substantial cost-savings for the NHS.

Keywords: anti-Müllerian hormone; assisted reproductive technology; birth rate; cost analysis; economic evaluation; family planning; fertility; ovarian reserve; screening.

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Conflict of interest statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.. Elapsed time, steps and patient's age once referred to medically assisted reproduction.
(A) First-line medically assisted reproduction as first choice. (B) Second-line medically assisted reproduction as first choice.
Figure 2.
Figure 2.. Model structure diagram.
*Infertility diagnosis is assumed, per definition AMH: Anti-Müllerian hormone; MAR: Medically assisted reproduction.
Figure 3.
Figure 3.. One-way sensitivity analysis results.
AMH: Anti-Müllerian hormone; MAR: Medically assisted reproduction; PC: Primary care.
See this image and copyright information in PMC

References

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    2. • Report developed from The National Council for Medically Assisted Procreation (CNPMA) detailing various trends and practice results in Portugal. This was used to both develop the model structure and clinical care pathway, as well as populate data elements.

    1. ESHRE. Factsheet on ART. www.eshre.eu/Europe/Factsheets-and-infographics (2020).

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