Aspetti organizzativi e gestionali dell’impiego di Fostimon nel trattamento dell’infertilità di coppia in L’impiego dell’ ormone follicolo stimolante (FSH) urinario umano nella riproduzione assistita: una valutazione di HTA

[Autom. eng. transl.] Infertility in couples represents an important health problem in our country that requires concrete assistance and organizational responses such as the introduction and implementation of PDTA, equity access to services, monitoring, outcome assessment and public reporting of results. The adoption of PDTA on PMA both in the hospital and in the territorial context would allow the realization of those integrated care profiles that constitute paths effectively oriented to continuity, integration and completeness of taking charge of the infertile couple. The heterogeneity of the distribution of PMA centers in the national territory determines a consistent phenomenon of interregional migration, influenced not so much by the number of centers present in the different regions as by the level and type of activity of the same. The data on the phenomenon of interregional migration is certainly a useful element to assess the quality of the offer in relation to the different accessibility to public services, the different reimbursement and the limits placed on the application of the techniques present in some Regions. On the basis of what has emerged, it would be necessary to evaluate the advisability of making uniform the methods of disbursement of the various procedures in order to avoid unequal treatment, limit the possible interregional migration and make the costs borne by the NHS homogeneous. Furthermore, the PMA National Register is an important resource as through the collection and evaluation of data it allows an adequate monitoring of the activity of the dispensing centers, the assessment of the outcomes and the public reporting of the results. Over the years, protocols for ovarian stimulation have been modified along with pharmacological developments. However, although recombinant FSH has been available on the market for several years, there is still no unanimous agreement to consider it first choice in ovarian stimulation cycles, preferring it to highly purified urinary FSH. In fact, in view of the high costs, the adoption of recombinant gonadotropins as first choice drugs should be subordinated to the demonstration of a superiority in terms of efficacy and safety with respect to highly purified urinary products; superiority currently not demonstrable based on the available scientific evidence.