title: Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation.
abstract: OBJECTIVE
  To compare cost and efficacy of tubal anastomosis to in vitro fertilization (IVF) in women who desired fertility after a tubal ligation.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Cost per ongoing pregnancy.
  
  
  RESULTS
  Cost per ongoing pregnancy for women after tubal anastomosis ranged from $16,446 to $223,482 (2014 USD), whereas IVF ranged from $32,902 to $111,679 (2014 USD). Across maternal age groups <35 and 35-40, years tubal anastomosis was more cost effective than IVF for ongoing pregnancy. Sensitivity analyses validated these findings across a wide range of ongoing pregnancy probabilities as well as costs per procedure.
  
  
  CONCLUSIONS
  Tubal anastomosis was the most cost-effective approach for most women less than 41 years of age, whereas IVF was the most cost-effective approach for women aged ≥41 years who desired fertility after tubal ligation. A model was created that can be modified based on cost and success rates in individual clinics for improved patient counseling.
authors.affiliation: Department of Obstetrics and Gynecology, St. Vincent Women's Hospital, Indianapolis, Indiana. Electronic address: lmessing@stvincent.org.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Messinger
authors.affiliation: South Florida Institute for Reproductive Medicine, Naples, Florida.
authors.forename: Connie E
authors.initials: CE
authors.lastname: Alford
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: John M
authors.initials: JM
authors.lastname: Csokmay
authors.affiliation: Reproductive Medicine Associates of Texas, San Antonio, Texas.
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Henne
authors.affiliation: Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Sunni L
authors.initials: SL
authors.lastname: Mumford
authors.affiliation: Reproductive Science and Women's Health Research, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: James H
authors.initials: JH
authors.lastname: Segars
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Alicia Y
authors.initials: AY
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000191:economics / Q000639:trends; D003362:Cost-Benefit Analysis / Q000639:trends; D003663:Decision Trees; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics* / Q000639:trends; D006801:Humans; D011247:Pregnancy; D013246:Sterilization, Tubal / Q000191:economics* / Q000639:trends
keywords: In vitro fertilization (IVF); bilateral tubal anastomosis (BTA); cost effectiveness; decision tree; tubal reversal