title: Cost-effectiveness of tubal patency tests.
abstract: OBJECTIVE
  Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Decision analytic framework.
  
  
  METHODS
  Computer-simulated cohort of subfertile women.
  
  
  METHODS
  We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment.
  
  
  METHODS
  Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio.
  
  
  RESULTS
  For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables.
  
  
  CONCLUSIONS
  The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.
authors: Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors: H R
authors: HR
authors: Verhoeve
authors: L M
authors: LM
authors: Moolenaar
authors: P
authors: P
authors: Hompes
authors: F
authors: F
authors: van der Veen
authors: B W J
authors: BW
authors: Mol
mesh_terms: D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005184:Fallopian Tube Diseases / Q000175:diagnosis*; D005186:Fallopian Tube Patency Tests / Q000191:economics*; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics*; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000191:economics / Q000628:therapy