title: Cost-effectiveness of hysteroscopy screening for infertile women.
abstract: This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed.
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands. j.c.kasius@umcutrecht.nl
authors.forename: Jenneke C
authors.initials: JC
authors.lastname: Kasius
authors.forename: René J C
authors.initials: RJ
authors.lastname: Eijkemans
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.forename: Bart C J M
authors.initials: BC
authors.lastname: Fauser
authors.forename: Human M
authors.initials: HM
authors.lastname: Fatemi
authors.forename: Frank J M
authors.initials: FJ
authors.lastname: Broekmans
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics*; D007247:Infertility, Female / Q000175:diagnosis*; D011247:Pregnancy; D011336:Probability