Cost--effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial.
BACKGROUND
In patients with ultrasound-visible hydrosalpinges, salpingectomy prior to IVF increases the chance of a live birth. This study compared the cost-effectiveness of this strategy (intervention) with that of optional salpingectomy after a failed cycle (control).


METHODS
Data from a Scandinavian randomized controlled trial were used to calculate the individual number of treatments and their outcomes. Only patients with ultrasound-visible hydrosalpinges were considered in the main analysis, and a maximum of three fresh cycles were included. The costs for surgical procedures, IVF treatment, medication, complications, management of pregnancy and delivery as well as of early pregnancy losses were calculated from standardized hospital charges.


RESULTS
Among the 51 patients in the intervention group, the live birth rate was 60.8% compared with 40.9% in 44 controls. The average cost per patient was 13,943 euro and 12,091 euro, respectively. Thus, the average cost per live birth was 22,823 euro in the intervention group and 29,517 euro in the control group. The incremental cost-effectiveness ratio for adopting the intervention strategy was estimated at 9306 euro.


CONCLUSIONS
The incremental cost to achieve the higher birth rate of the intervention strategy seems reasonable.
Strandell
Annika
A
Reproductive Medicine, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden. annika.strandell@medfak.gu.e
Lindhard
Anette
A
Eckerlund
Ingemar
I
D000328:Adult; D001723:Birth Rate; D001724:Birth Weight; D003362:Cost-Benefit Analysis; D003718:Denmark; D010064:Embryo Implantation; D004624:Embryo Transfer; D005184:Fallopian Tube Diseases / Q000191:economics* / Q000601:surgery*; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics* / Q000379:methods; D006801:Humans; D007055:Iceland; D007247:Infertility, Female; D009664:Norway; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography