title: Cost-effectiveness of assisted conception for male subfertility.
abstract: Intrauterine insemination (IUI), with or without ovarian stimulation, IVF and intracytoplasmatic sperm injection (ICSI) are frequently used treatments for couples with male subfertility. No consensus has been reached on specific cut-off values for semen parameters, at which IVF would be advocated over IUI and ICSI over IVF. The aim of this study was to evaluate the cost-effectiveness of interventions for male subfertility according to total motile sperm count (TMSC). A computer-simulated cohort of subfertile women aged 30 years with a partner was analysed with a pre-wash TMSC of 0 to 10 million. Three treatments were evaluated: IUI with and without controlled ovarian stimulation; IVF; and ICSI. Main outcome was expected live birth; secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. The choice of IVF over IUI with ovarian stimulation and ICSI over IVF depends on the willingness to pay for an extra live birth. If only cost per live birth is considered for each treatment, above a pre-wash TMSC of 3 million, IUI is less costly than IVF and, below a pre-wash, TMSC of 3 million ICSI is less costly. Effectiveness needs to be confirmed in a large randomized controlled trial.
authors.affiliation: Department of Gynaecology and Obstetrics, Academic Medical Center, Meibergdreef 91105 AZ, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands. Electronic address: lmmoolenaar@hotmail.com.
authors.forename: Lobke M
authors.initials: LM
authors.lastname: Moolenaar
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, the Netherlands.
authors.forename: Maarje
authors.initials: M
authors.lastname: Cissen
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, the Netherlands.
authors.forename: Jan Peter
authors.initials: JP
authors.lastname: de Bruin
authors.affiliation: Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, Netherlands.
authors.forename: Peter G A
authors.initials: PG
authors.lastname: Hompes
authors.affiliation: Department of Gynaecology and Obstetrics, Academic Medical Center, Meibergdreef 91105 AZ, Amsterdam, Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Repping
authors.affiliation: Department of Gynaecology and Obstetrics, Academic Medical Center, Meibergdreef 91105 AZ, Amsterdam, Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Department of Gynaecology and Obstetrics, Academic Medical Center, Meibergdreef 91105 AZ, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, University of Adelaide, SA 5005 Adelaide, Australia.
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000191:economics*; D008297:Male; D010062:Ovulation Induction; D027724:Reproductive Techniques, Assisted
keywords: cost-effectiveness; in vitro fertilization; intracytoplasmic sperm injection; intrauterine insemination; male subfertility