Cost-effectiveness of hysterosalpingography, laparoscopy, and Chlamydia antibody testing in subfertile couples.
OBJECTIVE
To evaluate the cost-effectiveness analysis of hysterosalpingography (HSG), laparoscopy, and Chlamydia antibody testing (CAT) in subfertile couples.


METHODS
Cost-effectiveness analysis.


METHODS
Decision analytic framework.


METHODS
Data of >2,000 subfertile couples in the Canadian Infertility Treatment Evaluation Study. Results of CA-125 measurement and CAT were simulated from baseline characteristics.


METHODS
Expectant management was considered to be the reference strategy (strategy 1). In strategy 2 and 3, IVF was offered either immediately or after 2.5 years. In strategy 4, the decision to offer or delay treatment was based on the couple's chance of spontaneous conception. Nine strategies incorporated combinations of CAT, CA-125 measurement, HSG, and laparoscopy.


METHODS
Expected live birth rates, expected number of IVF cycles, and expected total costs.


RESULTS
The strategy starting with CAT was the most cost-effective in couples whose 3-year chance of conception was >14%, whereas the strategy starting with HSG was the most cost-effective in couples with worse fertility prospects.


CONCLUSIONS
The diagnostic work-up to detect tubal pathology in subfertile couples should start with CAT in couples with relatively good fertility prospects and immediate HSG in couples with relatively poor fertility prospects.
Department of Obstetrics and Gynecology, Utrecht Medical Center, University of Utrecht, Utrecht, The Netherlands. bwmol@knmg.nl
B W
BW
Mol
J A
JA
Collins
F
F
Van Der Veen
P M
PM
Bossuyt
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D018394:CA-125 Antigen / Q000032:analysis; D002689:Chlamydia / Q000276:immunology*; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D005184:Fallopian Tube Diseases / Q000150:complications / Q000175:diagnosis; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007047:Hysterosalpingography / Q000191:economics*; D007246:Infertility / Q000191:economics / Q000209:etiology*; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D013997:Time Factors
D000907:Antibodies, Bacterial; D018394:CA-125 Antigen