Cost-effectiveness study of clomiphene citrate versus anastrozole for inducing ovulation in infertile adult patients in a public hospital, La Raza in Mexico City

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 ACE 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.