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

Rijswijk, Joukje van; Pham, Clarabelle T.; Dreyer, Kim; Verhoeve, Harold R.; Hoek, A. van den; Bruin, Jan-Peter de; Nap, Annemiek W.; Wang, Rui; Lambalk, Cornelis B.; Hompes, Peter G.A.; Mijatovic, V; Karnon, Jonathan; Mol, Ben Willem J.

doi:10.1016/j.fertnstert.2018.05.001

Cited by 20 publications

(20 citation statements)

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“…The costs of HyCoSy with sonographic contrast and HSG with water‐based contrast are considered similar, while HyFoSy may further reduce the cost. In HSG, oil‐based contrast is more expensive than is water‐based contrast, with an extra US$ 8198 for an additional ongoing pregnancy in ovulatory women with infertility at low risk for tubal pathology. Cost‐effectiveness should also be considered in shared decision‐making.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta‐analysis

Wang

Welie

Rijswijk

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To compare, in women with infertility, the effectiveness and safety of tubal flushing using oil-based contrast medium, water-based contrast medium or their combination, and no tubal flushing, and to evaluate the effectiveness of tubal flushing on fertility outcome over time. MethodsWe performed a systematic review and network meta-analysis, searching the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, up to 25 September 2018. We included randomized controlled trials (RCTs) comparing the following interventions with each other or with no intervention in women with infertility: tubal flushing using water-based contrast medium, tubal flushing using oil-based contrast medium or additional tubal flushing with oil-based medium following diagnostic tubal flushing with water-based medium. The outcomes included clinical pregnancy, live birth, ongoing pregnancy, miscarriage, ectopic pregnancy and adverse events. ResultsOf the 283 studies identified through the search, 14 RCTs reporting on 3852 women with infertility were included. Network meta-analysis showed that tubal flushing using oil-based contrast medium was associated with higher odds of clinical pregnancy within 6 months after randomization and more subsequent live births compared with tubal flushing using water-based medium (odds ratio (OR), 1.67 (95% CI, 1.38-2.03), moderate certainty of evidence ; and OR, 2.18 (95% CI,, ConclusionsIn women with infertility undergoing fertility workup, tubal flushing using oil-based contrast medium probably increases clinical pregnancy rates within 6 months after randomization and may increase subsequent live-birth rates, compared with tubal flushing using water-based contrast medium and compared with no intervention. Evidence on fertility outcomes beyond 6 months is inadequate to draw firm conclusions.

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Section: Discussionmentioning

confidence: 99%

Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta‐analysis

Wang

Welie

Rijswijk

et al. 2019

Ultrasound in Obstet & Gyne

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“…On the other hand, one could also argue that the threshold is dependent on the costs of an additional ongoing pregnancy. We showed in our economic evaluation of the H2Oil trial (with a difference of 10.7% in ongoing pregnancy rate) that when one accepts to pay $US 8,000 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared to HSG with water-based contrast (van Rijswijk et al , 2018a).…”

Section: Discussionmentioning

confidence: 99%

Tubal flushing with oil- or water-based contrast medium: can we identify markers that indicate treatment benefit?

Rijswijk

Welie

Dreyer

et al. 2019

Human Reproduction Open

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STUDY QUESTION Can we identify patient characteristics that distinguish which ovulatory infertile women undergoing hysterosalpingography (HSG) benefit more or less from flushing with oil-based contrast medium compared to water-based contrast medium? SUMMARY ANSWER In ovulatory infertile women, HSG with oil-based contrast medium resulted in higher 6-month ongoing pregnancy and live birth rates as compared to HSG with water-based contrast medium and this treatment effect was independent of characteristics of the couple. WHAT IS KNOWN ALREADY We recently showed that in infertile women undergoing HSG, flushing with oil-based contrast medium resulted in more ongoing pregnancies than flushing with water-based contrast medium. STUDY DESIGN, SIZE, DURATION We used data from our randomized clinical trial (RCT) in which 1,119 ovulatory infertile women undergoing HSG during fertility work-up were randomized for use of oil-based (N = 557) or water-based (N = 562) contrast medium. PARTICIPANTS/MATERIALS, SETTING, METHODS We built logistic regression models to predict ongoing pregnancy and live birth (secondary outcome) as a function of the specific contrast, the specific marker, and marker-by-contrast-interaction. Markers considered were female age, maternal ethnicity, female smoking, body mass index (BMI), duration of infertility, infertility being primary or secondary, sperm quality, and previous appendectomy. MAIN RESULTS AND THE ROLE OF CHANCE The 6-month ongoing pregnancy rates in the overall population were 39.7% after use of oil-based contrast versus 29.1% after use of water-based contrast medium [relative risk (RR), 1.37; 95% confidence interval (CI), 1.16–1.61; P < 0.001]. Among the studied baseline characteristics, BMI (P = 0.002) and semen volume (P = 0.02) were statistically significant prognosticators. The treatment effect of oil-based contrast was stronger in women with a BMI ≤30 kg/m2 [RR, 1.54; 95% CI, 1.23–1.92; P = 0.002], and in women whose partner had a semen volume >3 ml [RR, 1.77; 95% CI, 1.28–2.46; P = 0.02]. Also, in women who smoked, the treatment effect of flushing with oil was stronger, but this interaction did not reach statistical significance (P = 0.066). We found no positive effect of oil-based contrast in obese women. We found similar but weaker associations for live birth, which was probably due to lower number of events resulting in less power. LIMITATIONS, REASONS FOR CAUTION The RCT was restricted to infertile ovulatory women younger than 39 years of age without endocrinological disorders and at low risk for tubal pathology. Our results should not be generalized to infertile women who do not share these features. WIDER IMPLICATIONS OF THE FINDINGS All infertile, ovulatory women younger than 39 years with a low risk for tubal pathology will benefit from an HSG with oil-based contrast; therefore, this should be offered to them after fertility work-up. STUDY FUNDING/COMPETING INTEREST(S) The original H2Oil RCT was an investigator-initiated study that was funded by the two academic institutions (AMC and VUmc) of the Amsterdam UMC. The study displayed in this paper was funded by an unconditional research grant from Guerbet. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). K.D. reports consultancy for Guerbet, during the conduct of the study, and also reports research grants from Guerbet. C.B.L. reports grants from Guerbet, during the conduct of the study, and grants from Ferring, grants from Merck, and personal fees from Ferring, outside the submitted work. P.H. reports grants from Guerbet, during the conduct of the study, and grants from Ferring and Merck, outside the submitted work. V.M. reports receiving travel and speakers fee as well as research grants from Guerbet. B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, and Guerbet, and research grants from Guerbet and Merck. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER NTR 3270 www.trialregister.nl TRIAL REGISTRATION DATE 1 February 2012. DATE OF FIRST PATIENT’S ENROLMENT 3 February 2012.

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“…A cost-effectiveness analysis alongside a recent RCT showed incremental costs of performing an HSG with oil-based contrast compared with water-based contrast of USD 8,198 for one ongoing pregnancy in the United States. 128 The mean cost differences resulted in an ICER of USD 30,112 for the delivery of an additional child. The majority of the costs incurred per woman were for pregnancy and delivery.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…So if we are willing to pay USD 8,198 per additional ongoing pregnancy, an HSG with oil contrast is cost-effective. 128 However, the costs per IVF or ICSI (intracytoplasmic sperm injection) cycle, and thus the cost-effectiveness of tubal flushing, may vary greatly worldwide. Moreover, in some countries, IVF is not accessible for everyone or not available at all.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Tubal Flushing Treatment for Unexplained Infertility

et al. 2020

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Tubal patency testing was initially introduced as a diagnostic test. However, it has been observed that some tubal patency tests also have a therapeutic effect. This therapeutic effect can be influenced by the contrast medium used during tubal flushing. In this review, we discuss current evidence associated with different methods for tubal flushing and their potential impact on reproductive outcomes in women with unexplained infertility. Furthermore, we discuss their diagnostic accuracy, safety, and cost-effectiveness.

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

Abstract: Dutch Trial Register, NTR 6577 (www.trialregister.nl).

Cited by 20 publications

References 10 publications

Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta‐analysis

Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta‐analysis

Tubal flushing with oil- or water-based contrast medium: can we identify markers that indicate treatment benefit?

Tubal Flushing Treatment for Unexplained Infertility

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