Corifollitropin alfa versus daily recombinant FSH for ovarian stimulation in women of advanced maternal age: a cost-minimization analysis in an out-of-pocket setting.

Background: In many countries, Assisted Reproductive Technology (ART) remains funded predominantly out-of-pocket, with no private insurance reimbursement and only limited public provision. For many individuals, the cost of a single ART cycle may exceed monthly income, rendering treatment financially inaccessible. Therefore, even modest differences in medication costs can meaningfully influence treatment initiation and cycle completion. Aim: Given the limited regional evidence and the need for context-specific economic evaluations in Latin America, the present study aims to evaluate the economic impact of using Corifollitropin Alfa (CFA), a long-acting gonadotropin, compared with daily recombinant FSH for controlled ovarian stimulation (COS) in ART treatments in Brazilian women, under the assumption of equivalent clinical effectiveness. Method: A cost-minimization analysis was conducted from a Brazilian private-sector, out-of-pocket patient perspective, following national and international guidelines for healthcare economic evaluations. Medication reference prices, including taxes, were obtained from the official Brazilian regulatory database as of May 2025. Sensitivity analyses were performed to evaluate different gonadotropin dosing strategies in standardized COS protocols for women aged 35-42 years. Results: Across all scenarios tested, CFA was consistently associated with substantial cost reductions compared with daily rFSH. Assuming the equipotency between a single injection of CFA 150 µg and rFSH 300 IU/day for the first 7 days of COS, CFA plus follitropin alfa versus follitropin alfa alone reduced the pharmacological cost by approximately 52.1%. Similarly, CFA plus follitropin beta showed a reduction of approximately 56.3% in medication costs when compared to follitropin beta alone. These findings remained robust across all sensitivity analyses. Conclusion: CFA was associated with substantial pharmacological cost savings of more than 50% when compared to follitropin alfa or follitropin beta, assuming that a single injection of CFA 150 µg is equipotent to daily injections of rFSH 300 IU for the first 7 days of COS. Although further real-world studies are needed to validate and expand on these findings, this analysis provides meaningful evidence to support patient-centered decision-making and healthcare planning in resource-constrained settings.