Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis  

Oleh:

Moayeri, Sharon E. ; Lee, Henry C. ; Lathi, Ruth B. ; Westphal, Lynn M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Fertility and Sterility (keterangan: ada di ClinicalKey) vol. 92 no. 02 (Aug. 2009), page 471-480.
Topik: Cost effectiveness; dropout; endometriosis; in vitro fertilization; laparoscopy; unexplained infertility

Ketersediaan

Perpustakaan FK Nomor Panggil: F02.K.2009.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Objective : To evaluate the cost effectiveness of laparoscopy for unexplained infertility. Design : We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates. Setting : Academic in vitro fertilization practice. Patient(s) : Computer-simulated patients assigned to one of four treatments. Intervention(s) : Fertility treatment or laparoscopy. Main Outcome Measure(s) : Incremental cost-effectiveness ratios. Result(s) : Using base-case assumptions, LSC/EM was preferred (ICER =$128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments—SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity. Conclusion(s) : Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.

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