Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-05-05 Cooperative journals: 《中国全科医学》
Abstract： Background In the field of assisted reproductive technology，medical cost of patients is increasingly considered as an important reference for making treatment protocols，while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist （GnRH-ant） protocol and short-acting GnRH agonist（GnRH-a）long protocol in fresh embryo transfer. Objective To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching （PSM）. Methods A total of 1 971 patients treated with 2 117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET） at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1 549 patients with 1 685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation （COH）.Baseline data 〔including female age，type and duration of infertility，body mass index（BMI），age at menarche，number of pregnancies，follicle stimulating hormone（FSH），basal estradiol（E2），basal luteinizing hormone （LH），basal progesterone，antral follicle count（AFC），etc.〕，therapeutic indicators 〔including COH protocols，gonadotropin（Gn） durarion，total Gn dosage，E2，LH，progesterone level and endometrial thickness on the trigger day，number of retrieved and mature oocytes，fertilization methods，number of transferable embryos，high-quality embryos and transferred embryos，etc.〕 and the clinical outcomes〔including unpregnancy，miscarriage，ectopic gestation，live birth（LB）〕 were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2. Cost-effectiveness analysis was performed on the two groups after PSM，sensitivity analysis was applied to verify the robustness of the study findings. Results There were significant differences in female age，BMI，basal FSH，LH，and AFC between the two groups before PSM（P<0.05）. 390 cycles were included in each group after PSM，and there was no significant difference in female age，BMI，basal FSH，LH，and AFC between the two groups after PSM（P>0.05）. Therapeutic indicators including Gn duration，Gn dosage，E2 and endometrial thickness on the trigger day，number of retrieved and mature oocytes were lower in the GnRH-ant group than GnRH-a group，while LH level on the trigger day was higher in the GnRH-ant than the GnRH-a group（P<0.05） after PSM. Clinical outcomes including clinical pregnancy rate（43.08% vs. 54.62%，P=0.001），implantation rate（29.15% vs. 37.01%，P=0.001），and LB rate（33.59% vs. 44.10%，P=0.003） were significantly lower in the GnRH-ant group than GnRH-a group after PSM. The median cost of ovulation induction drug per cycle and median total cost per cycle were lower in the GnRH-ant group than the GnRH-a group after PSM（P<0.05）. Using LB rate as the endpoint indicator，cost-effectiveness analysis showed that the cost per LB was 66 397.92 and 54 226.33 yuan in the GnRH-ant group and GnRH-a group，respectively. The incremental cost-effectiveness ratio was 15 325.88 yuan，less than 1 time of per capita GDP in China in 2018（64 644 yuan）. The results of sensitivity analysis were consistent with the results of the basic analysis. Conclusion In fresh embryo transfer cycles，the clinical outcomes and economy performances of GnRH-a protocol are superior to GnRH-ant protocol.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-01-09 Cooperative journals: 《中国全科医学》
Abstract：
Background In the field of assisted reproductive technology, treatment cost of patients is increasingly seen as an important reference for making treatment plans, while domestic health economics research on the cost-effectiveness of gonadotropin-releasing hormone (GnRH) antagonist protocol and GnRH agonist short-acting protocol in fresh embryo transfer is relatively rare. Objective To explore the cost-effectiveness of GnRH antagonist protocol and GnRH agonist short-acting protocol in fresh embryo transfer by propensity score matching (PSM). Methods A retrospective analysis involving 432 GnRH antagonist protocol cycles and 1685 GnRH agonist short-acting protocol cycles in the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 was performed. A new sample of 390 pairs was obtained by PSM. Pregnancy outcomes and cost-effectiveness of the two groups after matching were analyzed. The research conclusion was verified by sensitivity analysis. Results After matching there were significant differences (P < 0.01) in clinical pregnancy rate (43.08% vs. 54.62%), implantation rate (29.15% vs. 37.01% ), live birth rate (33.59% vs. 44.10%), the average cost of medication per cycle (6533.50 � 2536.50 yuan vs. 7870.97�2566.74 yuan) and the total cost per cycle (23733.81 � 5647.82 yuan vs. 25313.54 � 5492.36 yuan) between GnRH antagonist protocol group and GnRH agonist short-acting protocol group. The cost per live birth in GnRH antagonist protocol group was 70657.37 yuan, which was higher than 57400.32 yuan in GnRH agonist short-acting protocol group. The incremental cost-effectiveness ratio is 15030.73 yuan, less than 1 time of China's per capita GDP in 2018 (64644 yuan). The results of sensitivity analysis and cost-effectiveness analysis were in consistency. Conclusion In fresh embryo transfer cycles, GnRH agonist short-acting protocol results in a better clinical outcome and cost-effectiveness than GnRH antagonist protocol.
Subjects: Computer Science >> Computer Application Technology submitted time 2018-11-13
Abstract： "
Peer Review Status:
Awaiting Review
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2017-12-07 Cooperative journals: 《南方医科大学学报》
Abstract： Objective To investigate the expression of anaplastic lymphoma kinase (ALK) gene fusion antibody in non-small cell lung cancer (NSCLC) and explore the clinicopathological significance. Methods Using manual immunohistochemistry (IHC) with D5F3 rabbit monoclonal antibody, we detected the expression of ALK gene fusion protein in 519 cases of NSCLC. The relations of ALK fusion protein with the clinical characteristics of the patients and the histological classification of the tumors were analyzed. The expressions of ALK fusion protein were compared between surgical specimens and biopsy samples, and the consistency of manual IHC results was evaluated with the results of a fully automated IHC instrument and fluorescence in situ hybridization (FISH). Results The positivity rate of ALK fusion protein was 11.37% (59/519) among the cases detected by manual IHC. The patients tended to have a young age of onset (P=0.048) and most of the tumors were adenocarcinoma. In the surgical specimens, ALK fusion protein was expressed mostly in invasive mucinous adenocarcinoma (P<0.01), and it was a high risk factor of lymph node metastasis [OR=2.188(95%C.I:1.161-4.122)]. No statistical difference was found in the test results of manual IHC between surgical specimens and biopsy samples. The results by manual IHC suggesting a strong expression were consistent with the results by automated IHC and FISH. Conclusion Manual IHC can be reliable for screening ALK fusion arrangement in patients with NSCLC.
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