title: Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness?
abstract: OBJECTIVE
  To apply Markov models to assess the cost effectiveness of the relative impact of obstructive interval and female partner age on fertility using either assisted reproductive technology (ART) or vasectomy reversal, and elucidate the impact of these variables on fertility.
  
  
  METHODS
  Markov models based on review of published literature and available ART outcome data.
  
  
  METHODS
  University-based clinical practice.
  
  
  METHODS
  Simulation runs of 50,000 patients for each analysis.
  
  
  METHODS
  Varying vasectomy obstructive interval and maternal age.
  
  
  METHODS
  Cost effectiveness, willingness to pay (WTP), and net health benefit.
  
  
  RESULTS
  Base case analysis showed ART yields a higher pregnancy rate and higher cost than vasectomy reversal. Sensitivity analysis showed female age has a greater effect on cost effectiveness than obstructive interval. At a WTP < $65,000, vasectomy reversal is more cost effective than ART. With increasing WTP, ART is more cost effective over wider windows of female age.
  
  
  CONCLUSIONS
  Markov modeling of fertility after vasectomy suggests female age has more impact than vasectomy obstructive interval on cost effectiveness.
authors.affiliation: University of California San Francisco, Department of Urology, San Francisco, California, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hsieh
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Turek
mesh_terms: D000328:Adult; D000367:Age Factors; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D005298:Fertility; D006801:Humans; D007248:Infertility, Male / Q000191:economics / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014669:Vasovasostomy / Q000191:economics*