Abstract
Purpose : The number of published studies comparing cost-effectiveness of tubal surgery and IVF treatment is limited, in part because of the difficulties of conducting randomized trials, given that IVF is now a clinically accepted treatment and the decision to offer surgery or IVF is often dictated by the severity of the tubal disease and by the availability of the methods. The aim of this study was to compare the costs of our policy of offering tubal surgery to patients with mild or moderate tubal disease with the cost of offering IVF to these and severe tubal disease.
Methods : In this retrospective cohort study patients with tubal pathology as the sole reason for their infertility were included: 61 patients in the tubal surgery group and 464 patients in the IVF group. The delivery rates and costs per delivery were compared.
Results : Delivery rates were 28% in the tubal surgery group within 2 years of follow-up and 52% in the IVF group that involved up to three cycles of treatment. This economic evaluation demonstrated only small differences in the average cost when considering the cost per delivery.
Conclusions : With a policy involving strict selection of patients, tubal surgery will continue to have a role in the treatment of infertility.
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References
Drummond M, Stoddart G, Labelle R, Cushman R: Health Economics: An introduction for clinicians. Ann Intern Med 1987;107:88-92
Detsky AS, Naglie IG: A clinician's guide to cost-effectiveness analysis. Ann Intern Med 1990;113:147-154
Drummond M, Stoddart G, Torrance G: Methods for the Economic Evaluation of Health Care Programmes. Oxford, UK, Oxford Medical Publications, 1987
Van Voorhis BJ, Stowall DW, Allen BD, Syrop CH: Cost-effective treatment of the infertile couple. Fertil Steril 1998;70:995-1005
Holst N, Maltau JM, Forsdahl F, Hansen LJ: Handling of tubal infertility after introduction of in vitro fertilization: Changes and consequences. Fertil Steril 1991;55:140-143
Haan G, Van Steen R: Cost in relation to effects of in-vitro fertilization. Hum Reprod 1992;7:982-986
Daya S: Comparison of IVF with conventional treatment for tubal infertility. Spécial congrès Vichy–IFFS 1995, pp. 206-214
Mage G, Pouly JL, de Joliniere JB, Chabrand S, Riouallon A, Bruhat MA: A preoperative classification to predict the intrauterine and ectopic pregnancy rates after distal tubal microsurgery. Fertil Steril 1986;46:807-810
Eisenberg JM: A guide to the economic analysis of clinical practices. JAMA 1989;262:2879-2886
Granberg M, Wikland M, Hamberger L: Financing of IVF/ET in the Nordic countries. Acta Obstet Gynecol Scand 1998;77:63-67
Eddy D: Applying cost-effectiveness analysis. JAMA 1992;268:2575-2582
Ubel PA, De Kay ML, Baron J, Asch DA: Cost-effectiveness analysis in a setting of budget constraints, is it equitable? N Engl J Med 1996;334:1174-1177
Penzias A, DeCherney AH: Is there ever a role for tubal surgery? Am J Obstet Gynecol 1996;174:1218-1223
Van Voorhis BJ, Stowall DW, Sparks AET, Syrop CH, Allen BD, Chapler FK: Cost-effectiveness of infertility treatments: A cohort study. Fertil Steril 1997;67:830-836
Philips Z, Barraza-llorens M, Posnett J: Evaluation of the relative cost-effectiveness of treatments for infertility in the UK. Hum Reprod 2000;15:95-106
Van Voorhis BJ, Stowall DW, Syrop CH: Cost-effective treatment for the couple with infertility. Clin Obstet Gynecol 2000;43:958-973
Copperman AB, Mukherjee T, Shaer J, Patel D, Sandler B, Grunfeld L, Bustillo M: A cost analysis of in vitro fertilization versus tubal surgery within an institution under two payment systems. J Womans Health 1996;5:335-341
Csemiczky G, Wramsby H, Landgren BM: High tubal damage is associated with low pregnancy rate in women undergoing in vitro fertilization treatment. Hum Reprod 1996;11:2438-2440
Strandell A, Lindhard A, Waldenström U, Thorburn J, Jansson PO, Hamberger L: Hydrosalpinx and IVF outcome: A prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod 1999;14:2762-2769
Hammarberg K., Astbury J., Baker H.W.G: Women's experience of IVF: A follow-up study. Hum Reprod. 2001;16:374-383
Bergh C, Borg G, Friden B, Olivius C: Why do couples with infertility interrupt treatment? XIV Nordic IVF Meeting, Lillehammar, Norway, Jan2002 (Abstract Book NW4 2002)
Ehnskog A, Henriksson M, Unander M, Brannstrom M: Prospective study of the clinical and laboratory parameters of patients in whom ovarian hypestimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril 1999;71:808-814
Vilska S, Tiitinen A, Hydén-Granskog C, Hovatta O: Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk for multiple birth. Hum Reprod 1999;14:2392-2395
Strandell A, Bergh C, Lundin K: Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod 2000;15:2520-2525
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Granberg, M., Strandell, A., Thorburn, J. et al. Economic Evaluation of Infertility Treatment for Tubal Disease. J Assist Reprod Genet 20, 301–308 (2003). https://doi.org/10.1023/A:1024853322988
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DOI: https://doi.org/10.1023/A:1024853322988