Fertility options after vasectomy: a cost-effectiveness analysis.
OBJECTIVE
To evaluate cost per delivery using two different initial approaches to the treatment of postvasectomy infertility.


METHODS
Model of expected costs and results in the United States in 1994.


METHODS
Men with postvasectomy infertility, evaluated and treated at centers with experience in vasectomy reversal or sperm retrieval and ICSI.


METHODS
Men with postvasectomy infertility, with a female partner < or = 39 years of age.


METHODS
Initial microsurgical vasectomy reversal was compared with retrieved epididymal or testicular sperm. Actual treatment charges, complication rates, and pregnancy and delivery rates obtained in the United States were used for cost per delivery analysis.


METHODS
Cost per delivery, delivery rates.


RESULTS
Cost per delivery with an initial approach of vasectomy reversal was only $25,475. (95% confidence interval $19,609 to $31,339), with a delivery rate of 47%. However, the cost per delivery after sperm retrieval and ICSI was $72,521. (95% confidence interval $63,357 to $81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. The delivery rate after one cycle of sperm retrieval and ICSI was 33%.


CONCLUSIONS
The most cost-effective approach to treatment of postvasectomy infertility is microsurgical vasectomy reversal. This treatment also has the highest chance of resulting in delivery of a child for a single intervention.
Pavlovich
C P
CP
James Buchanan Brady Foundation. Department of Urology, New York Hospital-Cornell Medical Center, New York 10021, USA.
Schlegel
P N
PN
D003362:Cost-Benefit Analysis; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D011247:Pregnancy; D013243:Sterilization Reversal / Q000191:economics; D014659:Vasectomy