Cost‐effectiveness of tubal patency tests

Abstract

Objective Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment.Design Cost-effectiveness analysis.Setting Decision analytic framework.Population Computer-simulated cohort of subfertile women.Methods We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment.Main outcome measures Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio.Results For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables.Conclusions The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.

Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effective analysis of a randomized controlled trial

“…To our knowledge, this is the first economic evaluation comparing the use of oil-based contrast to water-based contrast at an HSG in infertile women. Verhoeve et al (12) performed a computer-simulated cohort trial evaluating six scenarios of diagnostics and treatment in infertile women, with the primary outcome being ongoing pregnancy within 3 years. The scenarios were no tests and no treatment, immediate treatment without tubal testing, delayed treatment without tubal testing, an HSG followed by immediate or delayed treatment according to diagnosis (tailored treatment), HSG and a diagnostic laparoscopy in case HSG does not prove tubal patency followed by tailored treatment, and diagnostic laparoscopy followed by tailored treatment.…”

Leerboek seksuologie

“…Als een diagnostische test wordt uitgevoerd is het kosteneffectiever om eerst een HSG te plannen en het beleid af te laten hangen van de bevindingen. De uitkomsten van de studie werden niet beïnvloed door aanwezigheid van milde endometriosis of door de prevalentie van bilaterale tubapathologie (Verhoeve et al, 2013).…”

Low-cost in vitro fertilization: current insights

“…Clinical and cost effectiveness of the above methods for tubal assessment has been evaluated. Compared to laparoscopy as a test for tubal obstruction, HSG provided pooled estimates of sensitivity of 0.65 and specificity of 0.83, with a cost difference of €753 2,30,31. Hystero-salpingo-contrast sonography has been shown to exhibit good statistical comparability and concordance with HSG 2,32…”