The Meta-analysis Of DHEA In POR And The Pharmacoeconomics Evaluation Of Two Drugs

Part I Effectiveness of dehydroepiandrosterone in poor ovarian responders undergoing in vitro fertilization:a Meta-analysis of randomized controlled trialsObjective:This Meta-analysis aimed to evaluate whether DHEA could improve the probability of pregnancy in poor ovarian responders undergoing IVF/ICSI cycles.Methods:Electronic literature searches were carried out in MEDLINE,Scopus,EMBASE,Cochrane,CNKI,Wanfang,and VIP databases up to Augest 2017.All randomized controlled trials in which pretreatment with DHEA was compared with placebo or blank control were identified.Standard Meta-analytic methodology was used for the combination of results and the exploration of bias.Results:The primary outcome was clinical pregnancy rate,the secondary outcomes were the number of retrieved oocytes,cancellation rate,E2 level on the day of hCG administration,miscarriage rate,and total dose of gonadotropin units.A total of nine studies(1072 cases)met the inclusion criteria.The clinical pregnancy rate(OR:1.64,95%CI:1.20-2.24;P=0.002),the number of retrieved oocytes(MD:1.27,95%CI:0.60-1.94;P=0.0002)were significantly higher and the cancellation rate(OR 0.54,95%CI:0.33-0.87;P=0.01)was significantly lower in the DHEA group.Miscarriage rate(OR:0.54,95%Cl:0.24-1.22;P=0.14),E2 level on the day of hCG administration(MD:-13.62,95%CI:-300.33-273.10;P=0.93),and total dose of gonadotropin(MD-257.40;95%CI:-696.45-181.66;P=0.25)did not significantly differ between two groups.There was not significantly publish bias between the two groups.Conclusion:Based on the present Meta-analysis,pre-IVF DHEA treatment may improve the clinical pregnancy rate,increase the number of retrieved oocytes and lower the cancellation rate.The miscarriage rate,total dose of gonadotropin,and E2 level on the day of hCG administration were not affected.Part? cost-Effectiveness of two treatment protocols in poor ovarian responders undergoing in vitro fertilizationObjective:To estimate the pharmacoeconomics of DHEA and GH for IVF in women with POR,and support the clinicians to make the better therapeutic decision.Methods:We performed a Meta-analysis of RCTs on DHEA in previous part and searched the Meta-analysis of RCTs on GH in MEDLINE for POR by using evidence-based Medicine and obtained relevant therapeutic efficacy.Decision-tree model was established on the basis of literatures.The results of Meta-analysis were used to estimate the probability of each branch of decision-making tree and cost-effectiveness ratio of two kinds of therapeutic protocols.We also performed the sensitivity analysis to evaluate the stability of this model.Results:The decision-tree analysis revealed that the cost-effectiveness ratios of DHEA and GH were 88499.43 and 104340.79,respectively.Compared with DHEA group,GH group's ICER was 215230.26,less than 3 times of WTP.This protocol could be acceptable.Results of sensitivity analysis showed that DHEA was better than GH in term of economy.Conclusions:In this decision-tree model,with its underlying assumptions and data results,DHEA protocol is better in economy than GH protocol for the treatment of poor ovarian response.It still needs more data to confirm efficacy parameter,so the Pharmacoeconomics analysis will be closer to the actual therapy.