title: Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: "tap early and often" versus hospitalization.
abstract: OBJECTIVE
  To compare the cost of two treatment regimens for moderate to severe ovarian hyperstimulation syndrome (OHSS): conservative inpatient versus outpatient management with paracentesis.
  
  
  METHODS
  A decision-tree mathematical model comparing conservative inpatient versus outpatient management of moderate to severe OHSS was created. The common final pathway of either management was resolution of OHSS. Sensitivity analyses were performed over the range of variables.
  
  
  METHODS
  Total management cost of OHSS.
  
  
  RESULTS
  The cost of conservative therapy including first-tier complications was $10,099 (range $9,655-$15,044). The cost of outpatient management with paracentesis was $1954 (range $788-$12,041). This resulted in an estimated cost savings of $8145 with outpatient management with paracentesis. One-way sensitivity analyses were performed. Varying the probability of admission after outpatient treatment still indicated that outpatient treatment was the most cost-effective (probability = 1.0, cost = $6110). Varying the duration of hospitalization with primary inpatient treatment was equal to outpatient treatment costs only at a stay of 0.71 days or shorter.
  
  
  CONCLUSIONS
  Our model suggests early outpatient paracentesis for moderate to severe OHSS is the most cost-effective management plan when compared with traditional conservative inpatient therapy. The cost savings for outpatient management persisted throughout a variety of outcome probabilities.
authors.affiliation: Walter Reed Army Medical Center, Washington, DC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Csokmay
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Yauger
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Henne
authors.forename: Alicia Y
authors.initials: AY
authors.lastname: Armstrong
authors.forename: John T
authors.initials: JT
authors.lastname: Queenan
authors.forename: James H
authors.initials: JH
authors.lastname: Segars
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D018803:Models, Economic; D016471:Ovarian Hyperstimulation Syndrome / Q000191:economics* / Q000628:therapy*; D019152:Paracentesis / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome