Cost-effectiveness of in vitro fertilization and embryo transfer.
OBJECTIVE
Economic analyses in reproductive medicine often fail to take into account the chances of treatment-independent conception. We compared the cost-effectiveness of several realistic strategies involving IVF using no treatment as the reference strategy.


METHODS
A decision tree was constructed for a subfertile couple in which the clinician had to decide whether to offer treatment with IVF. No treatment at all was used as the reference strategy.


METHODS
An analytic decision-making framework.


METHODS
Hypothetical subfertile couples.


METHODS
Two potential treatment approaches: three IVF cycles performed as soon as possible, or no treatment performed initially and then three or four IVF cycles performed if a pregnancy resulting in a live birth does not occur naturally after 212 years.


METHODS
The cost of establishing one pregnancy that results in a live birth.


RESULTS
The cost-effectiveness of IVF depended not only on the costs and expected success rates of IVF itself but also on the couple-specific chances of treatment-independent conception. Consequently, the cost-effectiveness of IVF is strongly dependent on the age of the female partner. This finding corresponds with everyday clinical experience.


CONCLUSIONS
Economic analyses in reproductive medicine should take into account the option of providing no treatment.
Mol
B W
BW
Academic Hospital Utrecht, University of Utrecht, Utrecht, The Netherlands. bwml@knmg.nl
Bonsel
G J
GJ
Collins
J A
JA
Wiegerinck
M A
MA
van der Veen
F
F
Bossuyt
P M
PM
D000328:Adult; D001723:Birth Rate; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004624:Embryo Transfer / Q000191:economics*; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics*; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D012680:Sensitivity and Specificity