title: A decision analysis of treatments for nonobstructive azoospermia associated with varicocele.
abstract: OBJECTIVE
  To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Simulation with a decision analytic model.
  
  
  METHODS
  Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI.
  
  
  METHODS
  Cost-effectiveness.
  
  
  RESULTS
  Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates.
  
  
  CONCLUSIONS
  Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th St., New York, NY 10021, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Philip S
authors.initials: PS
authors.lastname: Li
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.forename: Glenn
authors.initials: G
authors.lastname: Schattman
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
mesh_terms: D000465:Algorithms; D053713:Azoospermia / Q000150:complications* / Q000191:economics / Q000601:surgery / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011336:Probability; D053625:Sperm Retrieval / Q000191:economics; D013094:Spermatozoa / Q000502:physiology; D014646:Varicocele / Q000150:complications* / Q000191:economics / Q000601:surgery