Table B.13Typical treatment schedule and cost of antagonists and agonists in ovulation induction

Generic/proprietary nameDuration, route and treatment scheduleDose/dayDays of treatment per cycle (n)Price and unit advertised in BNF181 and total cost of antagonist or agonistMean dose gonadotrophinGonadotrophin days (n)Price and unit advertised in BNF181 and total cost of gonadotrophinTotal price (agonist/antagonist plus gonadotrophin)
Antagonists e.g. cetrorelix (brand name: Cetrotide®)Short Injection

5 days of gonadotrophin and then 5 days of gonadotrophin plus antagonist

(total 10 days)
250 micrograms5 daysNet price 250-microgram vial = £24.00

£24 x 5 days = £120
1500 iu (3000 iu for poorly responding patients)

150–300 iu/day, depending on patient characteristics
10

starting on 1st day of cycle
150-unit ampoule of gonal-f = £52.50

150-unit vial of puregon = £54.43

At 150 iu/day:

£52.50 x 10 days = £525 for gonal-f

£54.43 x 10 days = £544.30 for puregon

At 300 iu/day
(high dose):

2 x 150 units per day x 10 days = £1050 (rounded to nearest £10)
With low dose Gonal-f: £120 + £525 (Gonal-f) = £645

With high dose Gonal-f (or for 300 iu/day): £120 + £1050 = £1170

With low dose Puregon: £120 + £544.30 (Puregon) = £664.30

With high dose Puregon: £120 + £1090 = 1210

Range: £645—1170
Agonists e.g. nafarelin (brand name Synarel®)Long Nasal

Start agonist on 21st day of cycle for 2–3 weeks, then 10 days of gonadotrophin plus agonist

(total 24–31 days)
200 micrograms in each nostril, twice a day

= 800 micrograms per day
14 days (minimum duration) to 21 days (maximum duration)

plus 10 days while on gonadotrophin

= 96 doses (minimum duration)

= 124 doses (maximum duration)
200 micrograms per metered spray. Net price 30-dose unit = £32.28; 60-dose unit = £55.66

= £87.94 for 90 doses

= £111.34 for 120 doses
1500–3000 iu total

or

150–300 iu/day
10Minimum duration of agonist, high dose of gonadotrophin: £88 + 1050 = £1138

Maximum duration of agonist, high dose of gonadotrophin: £111 + £1050 = £1162

Minimum duration, low dose gonadotrophin: £88 + £535 (mean cost) = £623

Maximum duration agonist, high dose of gonadotrophin: £111 + £535 = £646

Range: £623–1138

From: Appendix B, Economic models

Cover of Fertility
Fertility: Assessment and Treatment for People with Fertility Problems.
NICE Clinical Guidelines, No. 11.
National Collaborating Centre for Women's and Children's Health (UK).
London (UK): RCOG Press; 2004 Feb.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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