title: Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of laparoscopy for unexplained infertility.
  
  
  METHODS
  We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates.
  
  
  METHODS
  Academic in vitro fertilization practice.
  
  
  METHODS
  Computer-simulated patients assigned to one of four treatments.
  
  
  METHODS
  Fertility treatment or laparoscopy.
  
  
  METHODS
  Incremental cost-effectiveness ratios.
  
  
  RESULTS
  Using base-case assumptions, LSC/EM was preferred (ICER =$128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments-SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity.
  
  
  CONCLUSIONS
  Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.
authors: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Stanford, California, USA. smoayeri@yahoo.com
authors: Sharon E
authors: SE
authors: Moayeri
authors: Henry C
authors: HC
authors: Lee
authors: Ruth B
authors: RB
authors: Lathi
authors: Lynn M
authors: LM
authors: Westphal
authors: Amin A
authors: AA
authors: Milki
authors: Alan M
authors: AM
authors: Garber
mesh_terms: D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004715:Endometriosis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology