Transcript Slayt 1

COST CUTTING
MEASURES IN IVF
PROF. DR. TEKSEN
CAMLIBEL
1
NEED OF IVF
FEWER THAN 20% WHO NEED IVF, USES IT
IN 48 COUNTRIES, UTILIZATION IS 289 C.P.M.A
ESTIMATED NEED IN 1500-3000
NUMBER OF CENTERS
HIGH COST
IF PRICE IS 10% LOWER, UTILIZATION IS 30%
HIGHER.
COLLINS JA 2002
2
COST CUTTING MEASURES IN IVF
NEED OF IVF
3000 IVF/ICSI CYCLES PER MILLION/PER ANNUM
OPTIMAL NEED 1500 CYCLES PER MILLION/PER ANNUM
IN TURKEY OPTIMAL NEED IS 105.000
ABOUT 40.000-50.000 CYCLES PERFORMED PER YEAR
˜ 200 M $ ECONOMY
3
COST IN TURKEY
850 (SGK) + 700 (PATIENT) + DRUGS (20%)
TOTAL 1950 TL/780 EURO
TO
5500 TL + DRUGS (2000 TL)
TOTAL 7500 TL/3000 EURO
4
COST OF IVF
COST OF IVF/GNI
WESTERN COUNTRIES
> 10 %
USA
> 25 %
3RD WORLD COUNTRIES
> 50 %
TURKEY
> 37 % (3000$/8000$)
5
COST IN THE WORLD
COST OR CHARGES PER IVF CYLE
COUNTRY
COST PER
CYCLE
ORIGINAL
CURRENCY
COLLINS JA 2002
YEAR OF
ESTIMATE
US 2002 COST
($)
REFERENCE
CANADA
5700
CAD
1995
4532
FLUKER et al (1996)
NETHERLANDS
3350
GUILDERS
1995
2042
GOVERDE et al (2000)
DENMARK
1900
STERLING
1994
3753
GRANBERG et al (1998)
FINLAND
1300
,
.
2568
,
ICELAND
2000
.
.
3950
,
NORWAY
1800
.
.
3555
,
SWEDEN
2100
.
.
4148
,
ITALY
5.85
LIRA (a)
1997
4326
MANTOVANI et al. (1999)
UK
1717
STERLING
1998
2955
PHILLIPS et al. (2000)
CHINA
1500
USD
1995
1908
SCHENKER AND SHUSHAN (1996)
HONG KONG
5000
.
,
6361 *
,
INDIA
2000
.
,
2545
,
INDONESIA
3000
.
,
3817
,
IRAN
1000
.
,
1272 *
,
ISRAEL
3000
.
,
3817
,
JAPAN
2500
.
,
3181
,
JORDAN
1500
.
,
1908
,
KOREA
1100
.
,
1400
,
LEBANON
4000
.
,
5089
,
MALAYSIA
4500
.
,
5725
,
PAKISTAN
1000
.
,
1272
,
SAUDI ARABIA
4000
.
,
5089
,
SINGAPORE
4500
.
,
5725
,
TAIWAN
3000
.
3817
,
THAILAND
2500
.
3181
,
,
ICSI CYCLES 17% MORE COSTLY IN USA
USA IS 37% MORE COSTLY THAN OTHER COUNTRIES
6
COST COMPONENTS OF IVF/ICSI
COST OF FERTILITY DEPARTMENT
GYNECOLOGISTS
IVF NURSES
ANESTHESIA
COST OF MEDICATIONS
CC, HMG, rFSH, HP FSH, HCG, rHCG, etc
LAB COSTS
EMBRYOLOGIST (S)
TECHINICIAN (S)
EQUIPMENT
SUPPLIES
OPU NEEDLES
MEDIUMS
CATHETERS
FALCON TUBES ETC
HOSPITAL CHARGES
INITIAL INVESTMENT
7
COST OF IVF
BOUWMANS 2008
PRICE OPTIONS OF THE TREATMENT
STAGES OF IN VITRO FERTILIZATION /
INTRACYTOPLASMIC SPERM INJECTION
70
60
COSTS
50
40
IVF
30
ICSI
20
10
0
HORMONAL
STIMULATION
OPU
1ET
EVALUATION
TREATMENT STAGE
8
STAFF COSTS
10 CASES
50 CASES
GYNECOLOGIST
10.000
100 VISIT
4 VISIT/DAY
1000 TL/CASE
400 EURO/CASE
500 VISIT
20 VISIT/DAY
200 TL/CASE
80 EURO/CASE
EMBRYOLOGIST+TECH.
8000 TL
800/CASE
320 EURO
160/CASE
64 EURO
ANESTHESIA
50 TL/20 EURO
100 TL/40 EURO
NURSE
1500 TL
150 TL/60 EURO
30 TL/12 EURO
9
COST OF IVF
MAX (10 CASE)
TL/EURO
MIN (50 CASES)
TL/EURO
r FSH
2280/912
HMG
460/184
ANTAGONIST
423/170
AGONIST
131/52
r HCG
74/30
HCG
7/3
VAG SUPP.
150/58
PROG. IN OIL
30/12
GYN.
1000/400
GYN.
200/80
EMB.
800/320
EMB.
160/64
ANEST.
75/30
ANEST.
75/30
NURSE
150/60
NURSE
30/12
EMB SUPP
900/357
EMB. SUPP.
360/144
TOTAL
5862/2344
TOTAL
1482/592
COST+MED
2925+2927
COST+MED
825+657
10
COST-MINIMIZATION
ANALYSIS
VARIABLE
HIGHLY PURIFIED
RECOMBINANT
hMG
FSH
---------------------------------------------------------------------------------------------------------------NO. OF PATIENTS
396
385
TOTAL PER PATIENT COST
(95% CI) (£)
2.423
(2.356-2,495)
2,.745
(2,658-2,830)
TOTAL COST PER ONGOING
10.781
14.284
PREGNANCY ((95% CI) (£)
(9.056-12.919)
(11.883-17.981)
---------------------------------------------------------------------------------------------------------------------------------------------------LLOYD 2003
11
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
12
COST OF IVF
MAX (10 CASE)
TL/EURO
MIN (50 CASES)
TL/EURO
r FSH
2280/912
HMG
460/184
ANTAGONIST
423/170
AGONIST
131/52
r HCG
74/30
HCG
7/3
VAG SUPP.
150/58
PROG. IN OIL
30/12
GYN.
1000/400
GYN.
200/80
EMB.
800/320
EMB.
160/64
ANEST.
75/30
ANEST.
75/30
NURSE
150/60
NURSE
30/12
EMB SUPP
900/357
EMB. SUPP.
360/144
TOTAL
5862/2344
TOTAL
1482/592
COST+MED
2925+2927
COST+MED
825+657
13
COST-MINIMIZATION
ANALYSIS
VARIABLE
HIGHLY PURIFIED
RECOMBINANT
hMG
FSH
---------------------------------------------------------------------------------------------------------------NO. OF PATIENTS
396
385
TOTAL PER PATIENT COST
(95% CI) (£)
2.423
(2.356-2,495)
2,.745
(2,658-2,830)
TOTAL COST PER ONGOING
10.781
14.284
PREGNANCY ((95% CI) (£)
(9.056-12.919)
(11.883-17.981)
---------------------------------------------------------------------------------------------------------------------------------------------------LLOYD 2003
14
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
15
HOW TO REDUCE IVF COST
MILD STIMULATION
TOTAL COST
COST+HMG 64%+ 4 ANT+HCG+PROG. IN OIL
1397 TL/ 558 EURO
(FSH START DAY 5)
16
MILD vs STANDARD
POLINDER 2007
17
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
MOD. NATURAL
18
HOW TO REDUCE IVF COST
MOD. NATURAL
TOTAL COST
COST+HMG 40%+ 4 ANT+HCG+PROG. IN OIL
1287 TL/ 514 EURO
HMG 4 DAYS+ANTAGONIST 4 DAYS)
19
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
MOD. NATURAL
NATURAL
20
HOW TO REDUCE IVF COST
NATURAL CYCLE
TOTAL COST
COST+HCG+PROG.IN OIL
862 TL/345 EURO
21
NATURAL CYCLE vs STANDARD
NARGUND 2001
Estimated costs for a hypothetical cohort of 100 couples
Natural cycle IVF
Cumulative pregnancy after four consecutive
cycles (%)
Stimulated cycle IVFa
46
44–65
396.92
1717.35
Cost per couple (£)
1315
5599–4879
Cost per pregnancy (£)
2864
12 721–7633
Cost per cycle (£)
aRanges
represent results for severe to mild tubal factor.
22
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
MOD. NATURAL
NATURAL
MINI-IVF
23
HOW TO REDUCE IVF COST
MINI IVF
COST+CLOMID+HCG+PROG. IN OIL
TOTAL COST
882 TL/355 EURO
24
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
MOD. NATURAL
NATURAL
MINI-IVF
IVM
25
HOW TO REDUCE IVF COST
IVM
TOTAL COST
COST+HCG+PROG.IN OIL
862 TL/345 EURO
26
HOW TO REDUCE IVF COST
PROTOCOL CHANGES
SHORT vs LONG
MILD STIMULATION
MOD. NATURAL
NATURAL
MINI-IVF
IVM
FROZEN CYCLE
DRUGS
rFSH – HMG
rHCG – HCG
VAG. SUPP vs PROG. IN OIL
SUPPLIES
MEDICAL STAFF
27
EMBRYOLOGY SUPPLIES
10 CASES
MIN
TL/EURO
MAX
TL/EURO
OPU NEEDLE
38/15
130/520
ET CATHETER
38/15
70/28
ICSI PIPETTE
40/16
60/24
HOLDING PIPETTE
15/6
50/20
DENUDATION PIPETTE
30/12
40/16
PLASTIC DISPOSABLE
25/10
±40/16
MEDIUMS
100/40
±300/120
TOTAL
286/114
± 690-900/276-360
MIN
MAX
286/114
900/360
50 CASES
MIN
286/114
MAX
592/236
* SOME MEDIUMS (HYALURONIDASE; VITRIFICATION VE EMBRYO THAW MEDIUMLAR) MAY BE PREPARED HOME MADE.
28
HOW ABOUT HARDWARE COSTS
5 YEAR COST
RENT
MICROMANIPULATOR
INCUBATORS (2)
LAMINAR FLOW
USG
ANDROLOGY
FREEZING
HGPA FILTER
SURGICAL TABLE
SURGICAL LAMP
PATIENT BEDS (3)
DECORATION
7000 TL
420.000 TL/168.000 EURO
30.000 EURO
20.000 EURO
25.000 EURO
20.000 EURO
20.000 EURO
5000 EURO
20.000 EURO
5.000 EURO
5000 EURO
3000 EURO
30.000 EURO
TOTAL
351.000 EURO
FOR 10 CASES/MONTH: 1462 TL/585 EURO
FOR 50 CASES/MONTH: 292 TL/117 EURO
29
TOTAL COST OF IVF
10 CASES (MAX)
TL/EURO
50 CASES (MIN)
TL/EURO
HARDWARE COST
1462/585
292/117
FIX COSTS
2925/1170
825/1170
2927/1170
-----------------7324/2935
657/1170
---------------1774/709
MED
30
CONCLUSIONS
•
•
•
•
•
•
•
•
•
•
•
IVF IS A COSTLY BUSSINES
RENTS ARE HIGH!
STAFF SALARIES
DRUGS SHOULD BE CHOSEN TO KEEP EXPENSES
DOWN.
PROTOCOLS CAN BE CHANGED TO KEEP
MEDICATION COST DOWN
FROZEN CYCLE BE ENCOURAGED.
OTHER THAN INCUBATORS, 2ND HAND EQUIPMENT
MAYBE CONSIDERED.
PRIVATE ELECTRIC CONTRACTS
TELEPHONE CONTRACTS
EMBRYOLOGYST CAN MAKE OR BREAK THE PROFITS.
COST IS REVERIBLY ASSOCIATED WITH CASE/MONTH
31
THANK YOU!
32