COST CUTTING MEASURES IN IVF

1. COST CUTTING MEASURES IN IVF PROF. DR. TEKSEN CAMLIBEL

2. 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

3. 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

4. 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

5. COST OF IVF COST OF IVF/GNI WESTERN COUNTRIES > 10 % USA > 25 % 3RD WORLD COUNTRIES > 50 % TURKEY > 37 % (3000$/8000$)

6. COST IN THE WORLD COST OR CHARGES PER IVF CYLE COLLINS JA 2002 ICSI CYCLES 17% MORE COSTLY IN USA USA IS 37% MORE COSTLY THAN OTHER COUNTRIES

7. 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

8. COST OF IVFBOUWMANS 2008 HORMONAL STIMULATION ET EVALUATION OPU

9. STAFF COSTS 10 CASES 50 CASES GYNECOLOGIST 100 VISIT 500 VISIT 10.000 4 VISIT/DAY 20 VISIT/DAY 1000 TL/CASE 200 TL/CASE 400 EURO/CASE 80 EURO/CASE EMBRYOLOGIST+TECH. 800/CASE 160/CASE 8000 TL 320 EURO 64 EURO ANESTHESIA 50 TL/20 EURO 100 TL/40 EURO NURSE 150 TL/60 EURO 30 TL/12 EURO 1500 TL

10. COST OF IVF MAX (10 CASE) MIN (50 CASES) TL/EURO 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

11. COST-MINIMIZATION ANALYSIS VARIABLE HIGHLY PURIFIED RECOMBINANT hMG FSH ---------------------------------------------------------------------------------------------------------------- NO. OF PATIENTS 396 385 TOTAL PER PATIENT COST 2.423 2,.745 (95% CI) (£) (2.356-2,495) (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

12. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG

13. COST OF IVF MAX (10 CASE) MIN (50 CASES) TL/EURO 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

14. COST-MINIMIZATION ANALYSIS VARIABLE HIGHLY PURIFIED RECOMBINANT hMG FSH ---------------------------------------------------------------------------------------------------------------- NO. OF PATIENTS 396 385 TOTAL PER PATIENT COST 2.423 2,.745 (95% CI) (£) (2.356-2,495) (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

15. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG MILD STIMULATION

16. HOW TO REDUCE IVF COST MILD STIMULATION TOTAL COST COST+HMG 64%+ 4 ANT+HCG+PROG. IN OIL1397 TL/ 558 EURO (FSH START DAY 5)

17. MILD vs STANDARDPOLINDER 2007

18. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG MILD STIMULATION MOD. NATURAL

19. 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)

20. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG MILD STIMULATION MOD. NATURAL NATURAL

21. HOW TO REDUCE IVF COST NATURAL CYCLE TOTAL COST COST+HCG+PROG.IN OIL 862 TL/345 EURO

22. NATURAL CYCLE vs STANDARDNARGUND 2001

23. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG MILD STIMULATION MOD. NATURAL NATURAL MINI-IVF

24. HOW TO REDUCE IVF COST MINI IVF TOTAL COST COST+CLOMID+HCG+PROG. IN OIL 882 TL/355 EURO

25. HOW TO REDUCE IVF COST PROTOCOL CHANGES SHORT vs LONG MILD STIMULATION MOD. NATURAL NATURAL MINI-IVF IVM

26. HOW TO REDUCE IVF COST IVM TOTAL COST COST+HCG+PROG.IN OIL 862 TL/345 EURO

27. 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

28. EMBRYOLOGY SUPPLIES * SOME MEDIUMS (HYALURONIDASE; VITRIFICATION VE EMBRYO THAW MEDIUMLAR) MAY BE PREPARED HOME MADE.

29. HOW ABOUT HARDWARE COSTS 5 YEAR COST RENT 7000 TL 420.000 TL/168.000 EURO MICROMANIPULATOR 30.000 EURO INCUBATORS (2) 20.000 EURO LAMINAR FLOW 25.000 EURO USG 20.000 EURO ANDROLOGY 20.000 EURO FREEZING 5000 EURO HGPA FILTER 20.000 EURO SURGICAL TABLE 5.000 EURO SURGICAL LAMP 5000 EURO PATIENT BEDS (3) 3000 EURO DECORATION 30.000 EURO TOTAL 351.000 EURO FOR 10 CASES/MONTH: 1462 TL/585 EURO FOR 50 CASES/MONTH: 292 TL/117 EURO

30. TOTAL COST OF IVF 10 CASES (MAX) 50 CASES (MIN) TL/EURO TL/EURO HARDWARE COST 1462/585 292/117 FIX COSTS 2925/1170 825/1170 MED 2927/1170 657/1170 ------------------ ---------------- 7324/2935 1774/709

31. 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

32. THANK YOU!